内镜下经唇下上颌窦入路切除侧颅底肿瘤  

Clinical application of endoscopic sublabial transmaxillary approach in resection of lateral skull base tumour

作　　者：柏瑞 孔建新 钱海鹏 刘昂斯 孟肖利 万经海 李学记 BAI Rui;KONG Jianxin;QIAN Hai-peng;LIU Ang-si;MENG Xiao-li;WAN Jing-hai;LI Xue-ji(Department of Neurosurgery First Hopital of Sharuci Medical University,Taiyuan 030001,P.R.China;Department of Neurosurgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,P.R.China)

机构地区：[1]山西医科大学附属第一医院神经外科,山西太原030001 [2]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院神经外科,北京100021

出　　处：《中华肿瘤防治杂志》2019年第5期330-335,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：首都临床特色应用研究与成果推广项目(Z161100000516118)

摘　　要：目的侧颅底肿瘤手术难度大,传统手术入路创伤大、显露不充分,目前内镜手术入路发展迅速,可避免传统手术入路的不足。本研究旨在探讨内镜经唇下上颌窦入路切除侧颅底肿瘤的手术方法和可行性,评价其治疗效果和优缺点。方法选取2013-12-01-2017-12-31中国医学科学院肿瘤医院采用经唇下上颌窦入路内镜手术切除侧颅底肿瘤患者9例,其中良性6例,恶性3例,单纯经唇下上颌窦入路8例,联合经鼻腔入路1例。结果 9例患者肿瘤均累及翼腭窝、侵及颞下窝,其中4例侵入中颅窝内,1例巨大肿瘤同时侵越中线、侵入眶内和中颅窝底。术后影像学复查显示,7例肿瘤全切除,2例近全切除。术后病理诊断神经鞘瘤5例,表皮样囊肿1例,恶性神经纤维性肿瘤1例,非霍奇金淋巴瘤1例,脊索瘤1例。平均随访时间21.3个月,1例复发,无病例死亡,所有患者有不同程度的术区面部麻木感。结论经唇下上颌窦入路内镜手术暴露侧颅底肿瘤路径更直接,操作更灵便,不仅拓展了手术范围,而且基本规避了鼻内并发症,为内镜手术切除侧颅底肿瘤较为理想的手术入路。OBJECTIVE The resection of lateral skull base tumors is complex. Traditional surgical approaches involve huge trauma and inadequate surgery field exploure. While endoscopic approach develops rapidly, it could avoid the defect of traditional surgical approaches. This study aimed to explore the procedure of endoscopic sublabial transmaxillary approach( ESTA) and to evaluate the feasibility and effectiveness of its clinical application, summarize the merits and demerits. METHODS Nine lateral skull base tumours were resected by ESTA (including 6 benign and 3 malignant) at National Cancer Center during 12-01-2013 to 12-31-2017. Eight cases uesd EST A, 1 case used ESTA combined endoscopic transnasal approach (ETNA). RESULTS All cases involved the pterygopalatine fossa and the inferior temporal fossa, 4 cases involved middle cranial fossa, In 1 case, the gaint tumour involved the orbit and the middle cranial fossa, crossed the middle line. The postoperative imaging review displayed that the tumors were removed totally in 7 patients, subtotally in 2 patients. Pathological pattern:5 schwannomas, 1 malignant neurofibroma, 1 epidermoid cyst, 1 non-hodgkin lymphoma and 1 chordoma. The mean follow-up was 21. 3 months, 1 case relapsed,no death,and all cases had varying degrees of facial numbness on affected sides. CONCLUSIONS Compared to ETNA, ESTA provides more direct exploure and flexible operation in the lateral skull base,which not only expands the surgery field,but also basically avoids the nasnal complications. ESTA may be regard as an ideal approach for endoscopic surgery of lateral skull base tumours.

关 键 词：内镜 侧颅底肿瘤 唇下 上颌窦 入路 

分 类 号：R737.9[医药卫生—肿瘤]