颅鼻沟通性肿瘤一期联合手术及颅底重建的早期疗效  

EARLY OUTCOME OF ONE-STAGE TRANSBASAL SURGERY COMBINED WITH TRANSNASAL SURGERY FOR CRANIONASAL TUMORS AND RECONSTRUCTION OF SKULL BASE

作　　者：蔡博文[1] 周良学[1] 安惠民[2] 陈兢[1] 惠旭辉[1] 乔小明[2] 刘进平[1] 姜曙[1] 

机构地区：[1]四川大学华西医院神经外科,成都610041 [2]四川大学华西医院耳鼻喉科,成都610041

出　　处：《中国修复重建外科杂志》2008年第5期589-592,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨颅鼻沟通性肿瘤的联合手术及颅底重建方法。方法2005年6月-2007年10月,收治颅鼻沟通性肿瘤20例。其中男10例,女10例;年龄13～77岁,中位年龄49岁。病程2个月～13年。临床表现:嗅觉减退14例,头痛11例,鼻塞9例,鼻衄8例,视力障碍4例,突眼4例,伴意识障碍2例。术前CT及MRI检查均示前颅窝底占位,向下侵及鼻窦、鼻腔,形成颅腔、鼻腔沟通,部分肿瘤突入眶内。CT骨窗示病变均伴不同程度筛板及周围骨质破坏。采用额下入路联合经鼻入路一期手术切除肿瘤,并采用带蒂骨膜瓣或"下拉式三明治"法行颅底重建。结果病理检查示恶性肿瘤8例,良性肿瘤12例。术后均恢复良好,无手术死亡。2例患者术后发生一过性脑脊液鼻漏,经腰穿持续引流治愈;无脑/脑膜膨出发生。18例获随访3个月～2年6个月。1例副鼻窦来源的神经内分泌癌术后3个月肿瘤复发,衰竭死亡;1例嗅母细胞瘤于术后15个月复发,另1例嗅母细胞瘤术后2年复发,未再治疗,死于颅内高压;1例鳞状细胞癌术后2年死于肿瘤广泛转移;1例粘液瘤术后半年残瘤增大。其余13例随访期内未见复发,均恢复正常生活或工作。结论额下入路联合经鼻入路能够一期手术全切颅鼻沟通性肿瘤,早期效果好;用带蒂的颅骨骨膜瓣修补颅底或用"下拉式三明治"法行颅底重建,取材简便,安全有效,并发症发生率低。Objective To investigate the microsurgical management of cranionasal tumors and the method of the reconstruction of the skull base. Methods From June 2005 to October 2007, 20 patients with cranionasal tumor were treated. There were 10 males and 10 females, aged between 13 and 77 years （median 49 years）. The disease course was 2 months to 13 years. The cranionasal tumors, proved by MRI and CT scans, located in the anterior skull base, paranasal sinus, nasal and/or orbit cavity. And their clinical presentations were listed as follows： dysosphresia in 14 patients, headache in 11 patients, nasal obstruction in 9 patients, epistaxis in 8 patients, visual disorder in 4 patients, exophthalmos in 4 patients and conscious disturbance in 2 patients. All 20 patients underwent transbasal surgery combined with transnasal surgery, and tumors were resected by one-stage operation. The skull base was reconstructed by surgical technique ＂Pull Down Sandwich＂ with pedicle periosteum flap. Results Tumors were resected by one-stage operation, and the anterior skull bases were reconstructed. Pathological examination showed 8 cases of malignant tumors and 12 cases of benign tumors. The total surgical excision was complete in 16 patients, and 4 patients with subtotal excision. There was no operative death. Eighteen patients were followed up 3 months to 2 years and 6 months. Transient cerebrospinal fluid rhinorrhea was found in 2 cases which were cured by lumbar drainage. And recurrence of tumor was observed in 5 patients 3 months to 2 years after operation. Conclusion Microsurgical operation via subfrontal approach assisted by transnasal endoscopy is an effective method in management of cranionasal tumors, with the advantages of reconstruction of the skull base with pedicle periosteum flap or ＂Pull Down Sandwich＂ and low complication rate.

关 键 词：颅鼻沟通性肿瘤 显微神经外科 鼻内镜技术 颅底重建 

分 类 号：R739.4[医药卫生—肿瘤]