累及前颅底肿瘤切除术后的修复重建  

Reconstruction of the anterior cranial base after resection of the anterior skull base tumor

作　　者：冯芝恩[1] Kyojin Kim 李博[1] 秦力铮[1] 李华[1] 李建华[1] 邢汝东[1] 韩正学[1] FENG Zhi-en;LI Bo;QIN Li-zheng;LI Hua;LI Jian-hua;XING Ru-dong;HAN Zheng-xue(Department of Oral and Maxillofacial-Head and Neck Oncology,Capital Medical University School of Stomatology,Beijing 100050,China)

机构地区：[1]首都医科大学口腔医学院口腔颌面头颈肿瘤科,北京100050

出　　处：《北京口腔医学》2019年第1期32-36,共5页Beijing Journal of Stomatology

基　　金：国家自然科学基金(81570957);北京市医院管理局临床医学发展专项(XMLX201819;XMLX201505);2017年东城区优秀人才项目

摘　　要：目的累及前颅底肿瘤术后颅内外沟通缺损的修复重建极具挑战,本研究探讨前颅底缺损修复重建中皮瓣选择、术后短期结果。方法 2009年8月至2018年1月,北京口腔医院头颈肿瘤团队完成的累及前颅底的颅内外沟通肿瘤修复重建患者16例纳入本研究。结果 16例患者中15例接受带蒂或游离皮瓣修复,其中背阔肌皮瓣6例,带蒂颞肌筋膜瓣4例,腓骨肌皮瓣3例,前臂皮瓣及股前外肌皮瓣各1例,手术成功率100%,未发生严重并发症。结论累及前颅底的颅内外沟通肿瘤修复重建是关乎治疗成败、防止发生致命并发症的关键。颅底缺损范围、颌面软硬组织缺损程度、既往手术及放疗史、皮瓣容积和显微血管条件等均是影响修复重建选择的局部因素。Objective To discuss the reconstruction of the anterior skull base after resection of anterior skull base tumor.Methods Clinical data of 16 patients who received reconstruction of combined intra-extracranial defects involving the anterior skull base with flaps were included in this study.Results Fifteen of 16 cases underwent reconstruction with pedicle or free flaps among which 6 cases were latissimus dorsi myocutaneous flap,4 cases were pedicle temporalis fascial flap,3 cases were fibula myocutaneous flap,one case was forearm flap,one case was anterolateral thigh flap,the only one patient was without flap(maxillary swing approach after tumor resection and reset).The overall success rate of flaps was 100%,and the donor and receient sites were primarily closed,with a low incidence of complications.Conclusion The repair and reconstruction of combined intra-extracranial defects is the key to success of the treatment and the prevention of fatal complications.The size of the defective areas in skull base,the extent of soft and hard tissue defects in the maxillofacial region,the history of previous surgery and radiotherapy,flap volume plus microvascular conditions were all local factors that influence the choice of repair and reconstruction.

关 键 词：前颅底 颅内外沟通缺损 修复重建 肿瘤 游离皮瓣 

分 类 号：R739.8[医药卫生—肿瘤]