侵犯颅底的头颈部肿瘤的手术治疗  

Resection of invasive head and neck neoplasms involving skull base

作　　者：王双乐[1] 江远仕[1] 李创伟[1] 杨楚[1] 林炘[1] 杨冬涛[1] 陈恩河[1] 

机构地区：[1]汕头市中心医院中山大学附属汕头医院耳鼻咽喉-头颈外科,广东汕头515031

出　　处：《临床耳鼻咽喉头颈外科杂志》2007年第15期703-705,708,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的：探讨侵犯颅底的头颈部肿瘤的手术治疗方法。方法：对32例侵犯前、侧颅底的头颈部肿瘤患者进行手术治疗,采用鼻内镜下鼻腔入路5例,颅-面联合入路3例,上颌骨切除入路15例,口腔硬腭入路1例,经下颌入路1例,颈侧-下颌骨切开入路2例,耳后-颈联合入路1例,额颞入路2例,经面入路2例。结果：4例鼻窦黏液囊肿仅作开放引流,1例脊索瘤作次全切除,其余27例患者均全切肿瘤,无手术死亡及严重颅脑并发症。8例良性肿瘤患者随访6个月~8年情况良好,无肿瘤复发及死亡。24例恶性肿瘤患者,术后随访3年以上19例,生存12例;随访5年以上12例,生存5例;术后3、5年生存率分别为63.2%（12/19）和41.7%（5/12）。结论：根据病变性质、部位及范围设计手术入路,力求全切肿瘤并保护重要结构,采用适当的颅底修复方法,可获得良好的治疗效果。Objective：To investigate the operative methods of invasive head and neck neoplasms involving skull base. Method：Thirty-two cases with invasive head and neck neoplasms involving anterior and lateral skull base, from 1997 to 2005,were treated with surgical resection. Nine surgical approaches including endoscopic transnasal approach for five cases, combined craniofacial approach for three cases, maxillary resection approach for 15 cases, transpalatal approach for one case, transmandibular approach for one case, lateral neck-mandibular incision approach for two cases, combined retroauricula and neck approach for one case, frontotemporal approach for two cases, and facial translocation approach for two cases were used to resect the tumors. Result： Four cases with nasal sinus mucocele were only applied drainage and one case with chordoma was subtotally resected. The tumors of Tthe rest 27 cases were totally removed. Although one case complicated with cerebrospinal fluid leak and recovered within one week, no one died from the operation and no serious cranium-cerebrum complication occurred. Eight cases with benign tumor were followed up for six months to eight years without recurence and no one died. For 24 cases with malignant tumor, survival rates of three and five years were 63.2 % （12/19）, 41.7 % （5/12） respectively. Conclusion：Surgical approach must be designed according to the pathological change＇s characters, site and invasive range. Favorable curative effect could he achieved by resecting tumors totally as possible, protecting important constitutions,and adopting proper reparative techniques.

关 键 词：头颈部肿瘤 颅底 外科手术 

分 类 号：R739.91[医药卫生—肿瘤]