侧颅底肿瘤切除术后缺损的修复重建  

Defect reconstruction after removal of tumor in lateral skull base

作　　者：陈立[1] 吴皓[1] 黄琦[1] 杨军[1] 贾欢[1] 张治华[1] 

机构地区：[1]上海交通大学医学院附属新华医院耳鼻咽喉头颈外科,上海200092

出　　处：《临床耳鼻咽喉头颈外科杂志》2009年第10期433-435,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨侧颅底肿瘤切除术后缺损的修复。方法:回顾性总结132例侧颅底肿瘤切除术后缺损的修复及愈后情况。病种包括听神经瘤(92例),颈静脉孔肿瘤(21例),颞下窝肿瘤(6例),鼻咽癌放疗后复发癌(4例),中耳癌(3例),桥小脑角的脑膜瘤(2例),蛛网膜囊肿(2例),颞骨鳞状细胞癌2例。修复部位包括硬脑膜、颅底骨、颧弓、颅底颞下窝的缺损。采用的材料有腹壁脂肪(113例)、颞肌及颞肌筋膜瓣(29例)、胸锁乳突肌肌瓣(19例)、胸大肌皮瓣(2例)、人工脑膜(1例)、钛板(1例)。结果:采用的带血管颞肌及颞肌筋膜瓣、胸大肌皮瓣、胸锁乳突肌肌瓣全部存活,用脂肪修复成功率为98.2%(111/113),脑脊液漏2例,无颅内感染发生。结论:根据侧颅底脑肿瘤的部位和不同类型的缺损,采用不同的修复材料和方法,肿瘤切除后颅底缺损的修复重建对术后功能的保留和恢复,避免脑脊液漏、颅内感染的发生,有着至关重要的作用,是侧颅底肿瘤手术成功的关键之一。Objective： To explore the methods of reconstruction for the defects of lateral skull base after removal of tumor. Method：One hundred and thirty two patients who underwent removal of tumor in the lateral skull base and reconstruction of defects after surgery were summarized retrospectively. They suffered from acoustic neuroma（92 cases）, the tumor in the jugular foramen（21 cases） , neoplasms in the infratemporal fossa（6 cases）, recurrent nasopharyngeal carcinoma after radiotherapy（4 cases）, cancer of middle ear（3 cases）, meningeoma（2 ca ses） ,arachnoid cyst in the cerebellopontine angle（2 cases）, and squamous cell carcinoma of the temporal bone（2 cases ）. The defects of dura mater membrane,basion, arcus jugalis, base of skull and infratemporal fossa were re- paired with the abdominal wall fat（ll3 cases） , temporal muscle and temproal musculofascial flap（29 cases）, sternocleidomastoideus muscle flap（19 cases）, major pectoral myocutaneous flap （2 cases）, the artificia mater（1 case）, titanium board（1 case）. Result： All muscle or myocutaneous flaps survived in these patients, and fat tissues survival rate was 98.2% （111/113）. Leakage of cerebrospinal fluid occurred in two patients after repairing with fat tissues. The intracranial infection was not found in these patients. Conclusion： According to the position of tumor in the lateral skull and different type of defect, different reconstructing methods and materials were used. The recon- struction in the lateral skull base and infratemporal fossa defect plays an important role to eliminate dead space, and avoid leakage of cerebrospinal fluid and intracranial infection, which is one of key points in the lateral base sur gery.

关 键 词：颅底 肿瘤 外科皮瓣 外科修复手术 

分 类 号：R739.91[医药卫生—肿瘤]