经鼻显微镜和神经内镜手术治疗颅底脊索瘤的比较研究  

Comparative study on transnasal surgical treatment of skull base chordoma with microscope vs neuroendoscope

作　　者：刘志勇[1] 周良学[1] 刘浩[1] 姜曙[1] 蔡博文[1] 徐建国[1] LIU Zhi-yong;ZHOU Liang-xue;LIU Hao;JIANG Shu;CAI Bo-wen;XU Jian-guo(Department of Neurosurgery,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院神经外科,四川成都610041

出　　处：《中国耳鼻咽喉颅底外科杂志》2018年第4期309-314,共6页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：中国博士后基金第62批面上项目资助(2017M623038);四川省科技计划项目(2014JY0256)

摘　　要：目的比较经鼻显微镜和神经内镜治疗颅底脊索瘤的疗效。方法回顾性分析四川大学华西医院神经外科2008年12月~2015年12月收治的56例颅底脊索瘤患者的临床资料,其中男性31例,女性25例;年龄16~77岁,平均42.6岁。按手术方式不同分为鼻显微镜组和神经内镜组,对两组手术疗效及并发症进行比较。结果经鼻显微镜下手术38例,全切除6例,次全切14例,部分切除18例,全切率为15.8%;经鼻神经内镜下手术18例,其中全切除10例,次全切4例,部分切除4例,全切率为55.6%。两组肿瘤全切率比较有统计学意义。患者症状改善和肿瘤全切率神经内镜组明显好于经鼻显微镜下手术组,两组比较有统计学意义(P<0.05)。并发症发生率两种手术方式无明显差异(P>0.05)。结论经鼻神经内镜下切除颅底脊索瘤其全切率明显提高,且其手术并发症率未明显增加,应其作为颅底脊索瘤的首选手术方式。Objective To compare the therapeutic eilbct of transnasal neurosurgery for skull base chordoma with microscope vs neuroendoscope. Methods Clinical data of 56 patients suffering from skull base chordoma hospitalized in our department from Dec. 2008 to Dec. 2015 were analyzed retrospectively. Of them, 31 were male and 25 were female, with an age range from 16 to 77 years （average age 42.6 years）. All the patients underwent transnasal tumor removal with with microscope （microscope group） or neuroendoscope （neuroendoscope group）. The therapeutic effect and complications between the two groups were compared. Results Of the 38 patients in the microscope group, total tumor resection was achieved in 6, subtotal resection in 14 and partial resection in 18, with a total tumor resection rate of 15.8%. Of the 18 patients in the neuroendoscope group, the total, subtotal and partial resections were achieved in 10, 4, and 4 cases respectively, with a total resection rate of 55.6%. The difference of total tumor resection rate between the two groups was statistically significant （ P 〈 0.05 ）. The symptom improvement in the neuroendoscope group was better than that in the microscope group, and the difference between the two groups was also statistically significant （ P 〈 0.05 ）. The difference of complication rate between the two groups was statistically insignificant （ P 〉 0.05 ）. Conclusion With high total tumor resection rate and no significant increase of complication rate, transnasal neuroendoscopic approach is preferred in the surgical treatment of skull base chordoma.

关 键 词：颅底脊索瘤 经鼻手术 显微镜 神经内镜 手术疗效 并发症 

分 类 号：R651.11[医药卫生—外科学]