头颈外科神经外科联合手术治疗颅底沟通肿瘤  

Cooperation management by head and neck surgery and neurosurgery for skull base tumors

作　　者：吴跃煌[1] 万经海[2] 祁永发[1] 徐震纲[1] 唐平章[1] 郭京[3] 

机构地区：[1]中国医学科学院肿瘤医院头颈外科,北京100021 [2]中国医学科学院肿瘤医院神经外科,北京100021 [3]中日友好医院神经外科

出　　处：《中华耳鼻咽喉头颈外科杂志》2009年第6期475-479,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：北京希望马拉松专项基金（LC2006A04）

摘　　要：目的介绍头颈外科与神经外科合作处理颅底沟通肿瘤的经验和优势。方法回顾性分析2005年7月至2008年7月头颈外科和神经外科联合制定手术方案并共同实施手术54例（良性21例，恶性33例）颅底沟通肿瘤的临床资料，其中前颅底19例，侧颅底12例，中央颅底17例，后颅底（颈静脉孔区）6例。结果本组颅底沟通肿瘤均一期手术切除。良性肿瘤全切除20例，近全切除1例；恶性肿瘤肉眼全切除25例，6例鼻窦、鼻咽、腮腺恶性肿瘤及2例脊索瘤近全切除。无手术死亡病例，恶性肿瘤并发症13例，其中术后出血2例。随访8～43个月，良性与恶性肿瘤中位随访时间分别为19．1及21．0个月，恶性患者失访3例。21例良性肿瘤复发1例。33例恶性肿瘤中复发12例，死亡9例（其中1例死于心脏病），Kaplan-Meier法统计3年生存率与无瘤生存率分别为53．0％及52．7％。结论头颈外科和神经外科合作有利于提高颅底沟通肿瘤的手术切除率从而提高治疗效果。Objective To present the experience and advantage of cooperation management by head and neck surgery and neurosurgery for communicating skull base tumors. Methods A review of 54 communicating skull base tumors （ benign tumor 21, malignant tumor 33 ） cooperation resection by head and neck surgery and neurosurgery from July 2005 to July 2008 in the Cancer Hospital of Chinese Academy of Medical Sciences was presented. The tumor originated in the anterior skull base in 19 cases, originated in the lateral skull base in 12, in the central skull base in 17, and in the posterior skull base in 6. Results All procedures were conducted in a single stage by a multidisciplinary team. Total resection of tumor was achieved in 45 cases, and subtotal resection was achieved in 9. There was no operative death. There were 2 cases postoperative hemorrhage. All cases except 3 were followed up with a period of 8 to 43 months （median, 19. 1 months for benign tumor and 21.0 months for malignant tumor）. Three patients with malignant tumor were lost. Twelve cases of malignant tumor and one case of benign tumor recurred postoperatively. Nine patients with malignant tumor had died（ one of these died from heart trouble）. Threeyear disease-free survival rates and overall survival rates of malignant tumor were 52. 7% and 53.0% , respectively. Conclusions It suggested that a special operative team constituted of head and neck surgeon and neurosurgeon may improve the outcome of the difficult skull base tumors.

关 键 词：头颈部肿瘤 颅底肿瘤 耳鼻喉外科手术 神经外科手术 

分 类 号：R686[医药卫生—骨科学]