鼻内镜下经鼻蝶斜坡脊索瘤的手术治疗  

Surgical treatment of chordoma in clival area through endoscopic transsphenoidal approach

作　　者：杨强[1] 李强[1] 潘亚文[1] 董志强[1] 张祎年[1] 李峤[1] 

机构地区：[1]兰州大学第二医院神经外科,甘肃兰州730000

出　　处：《中国耳鼻咽喉颅底外科杂志》2016年第3期216-219,共4页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：2014年甘肃省卫生行业科研管理项目(GWGL 2014-09);兰州市2015年第二批科技计划项目(2015-2-62)

摘　　要：目的 探讨鼻内镜经鼻蝶入路手术治疗斜坡区脊索瘤的手术方法和临床效果.方法 2010年3月-2015年4月收治13例斜坡区脊索瘤患者,运用鼻内镜经鼻蝶入路切除位于颅底斜坡的脊索瘤,未能全切除者术后辅以放射治疗,杀灭残留的肿瘤组织.结果 经鼻蝶内镜下全切肿瘤6例,次全切除4例,大部分切除3例.术后临床症状得到不同程度改善10例,无明显缓解3例,术后辅助放疗.随访3个月至4年,4例术后2年复发,行再次手术,1例出现脑脊液鼻漏,行漏口修补后好转出院,其余患者肿瘤无复发.术后3例患者症状无明显缓解,患者年龄大,一般情况较差,未再次行手术治疗.结论 鼻内镜下经鼻蝶入路切除主要位于中,上斜坡的脊索瘤,手术入路短,术中深部结构辨认清晰,相对于其他手术入路,该入路创伤小、安全、用时少,疗效满意.是斜坡脊索瘤治疗的一种较好的手术入路.Objective To discuss the surgical method and clinical effect of endoscopic transsphenoidal approach in the treatment of chordoma in clival area. Methods Thirteen cases with clival area chordoma were admitted to our department from Mar 2010 to Apr 2015. Endoscopic transsphenoidal approach was taken to resect the chordoma of the sphenoid bone and clivus, and those whose tumor couldnt be removed totally were given postoperative radiotherapy in order to kill the residual tumorous ceils. Results Total resection was performed in 6 cases, subtotal resection in 4, partial resection in 3. Clinical symptoms in 10 cases were relieved after operation and 3 cases had no obvious remission. All the patients were given postoperative radiotherapy. Postoperative follow-up period ranged from 3 months to 4 years. Tumor recurrence occurred in 4 cases and reoperations were performed. Cerebrospinal fluid rhinorrhea was repaired surgically in one case. Three cases without obvious symptom-remission after operation now survived with tumor. Conclusions Endoscopic transsphenoidal approach is adapted to resect chordoma of middle and upper clivus. With advantages of minimal invasion, safety, timesaving and good results, endoscopic transsphenoidal approach is preferable for the treatment of chordoma in clival area.

关 键 词：脊索瘤 斜坡 颅底 内镜外科 

分 类 号：R739.41[医药卫生—肿瘤]