神经内镜经鼻入路切除颅底肿瘤术中颅底重建的临床疗效  

Clinical outcomes of intraoperative skull base reconstruction in endoscopic endonasal skull base tumor resection

作　　者：陈政源 寿雪飞 沈明 何文强 张柯怡 赵曜 李士其 钟平 王镛斐 Chen Zhengyuan;Shou Xuefei;Shen Ming;He Wenqiang;Zhang Keyi;Zhao Yao;Li Shiqi;Zhong Ping;Wang Yongfei(Department of Neurosurgery,Huashan Hospital,Fudan University,Shanghai 200031,China)

机构地区：[1]复旦大学附属华山医院神经外科,上海200031

出　　处：《中华神经外科杂志》2020年第1期2-6,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金青年科学基金(81602191);2017年度上海市"科技创新行动计划"生物医药领域科技支撑项目指南(17441901400)。

摘　　要：目的总结神经内镜经鼻入路切除颅底肿瘤术中颅底缺损的修补策略和疗效。方法回顾性分析2011年4月至2016年2月于复旦大学附属华山医院神经外科接受神经内镜经鼻入路颅底肿瘤切除术中出现颅底缺损的202例患者的颅底重建疗效。术中根据硬膜缺损直径和脑脊液流量将颅底缺损分为Ⅰ~Ⅲ级,对不同分级的患者采用相应的颅底重建策略。结果202例患者中,颅底缺损Ⅰ级者占15.8%(32例)、Ⅱ级者占24.3%(49例)、Ⅲ级者占59.9%(121例)。术后发生脑脊液鼻漏6例(3.0%),接受再次神经内镜修补手术后均获得成功。术后颅内感染4例(2.0%),予以抗感染治疗后均痊愈。1例(0.5%)老年患者手术后因长期卧床并发肺部感染死亡。结论应用神经内镜修补颅底缺损安全、有效。根据不同颅底缺损分级采用相应的修补策略,可有效避免术后脑脊液漏的发生。Objective To summarize the reconstruction strategy and efficacy for skull base defect in endoscopic endonasal skull base tumor resection.Methods The clinical outcomes of 202 patients with skull base defect who underwent endoscopic tumor resection at Department of Neurosurgery,Huashan Hospital,Fudan University from April 2011 to February 2016 were retrospectively analyzed.Skull base defects were intraoperatively classified intoⅠ-Ⅲgrades based on the diameter of dura defect and flow of cerebrospinal fluid(CSF),and corresponding reconstruction strategies were adopted.Results The classification result of 202 skull base defects was 15.8%(32 cases)in GradeⅠ,24.3%(49 cases)in GradeⅡand 59.9%(121 cases)in GradeⅢ.Six patients(3.0%)had postoperative CSF rhinorrhea,which resolved following secondary endoscopic repair surgery.Four patients(2.0%)had intracranial infection which was finally cured by antibiotics medication.One elderly patient(0.5%)died of pulmonary infection after prolonged bed rest after surgery.Conclusions Endoscopic surgery seems safe and effective for the reconstruction of skull base defect.The occurrence of postoperative CSF leakage could be effectively avoided when specific reconstruction strategy is adopted according to the classification of skull base defect.

关 键 词：自然腔道内镜手术 颅底肿瘤 修复外科手术 颅底缺损 

分 类 号：R73[医药卫生—肿瘤]