颞下窝肿瘤切除术的围手术期处理  

Perioperative management for surgical resection of infratemporal fossa tumors

作　　者：危维[1] 杨晓彤[1] 严波[1] 吕海丽[1] 王振霖[1] 张秋航[1] WEI Wei;YANG Xiao-tong;YAN Bo;LYU Hai-li;WANG Zhen-lin;ZHANG Qiu-hang(Department of Otolaryngology Head and Neck Surgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院耳鼻咽喉头颈外科

出　　处：《中国耳鼻咽喉颅底外科杂志》2019年第6期620-624,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：国家自然科学基金面上项目(81670904)

摘　　要：目的总结颞下窝肿瘤切除术的围手术期处理经验。方法回顾性分析首都医科大学宣武医院2013年9月-2018年8月收治的154例颞下窝肿瘤患者的临床资料。术前评估包括专科检查、颅底CT及增强MRI,32例患者行术前数字减影血管造影(DSA)检查。采用内镜经鼻入路手术105例,经颈入路26例,经面入路23例。结果 37例患者术中输血。内镜经鼻入路全切率90.5%(95/105),4例患者术后出现脑脊液鼻漏,经保守治疗及换药后治愈,无颅内感染;2例患者术后出血,再次手术止血;1例患者术后出现颈内动脉痉挛、脑梗死,经抗血管痉挛、激素、脑保护剂等治疗后好转。经颈入路全切率100.0%(26/26),5例患者行预防性气管切开术,术后对症支持治疗后顺利拔管。经面入路全切率95.7%(22/23)术后行补液及营养支持治疗。结论颞下窝肿瘤切除术的围手术期处理包括术前评估、术中输血、术后并发症等诊治,正确及时的围手术期处理对患者的早期恢复尤为重要。Objective To summarize our experience with the perioperative management of patients with infratemporal fossa tumors.Methods Clinical data of 154 patients with infratemporal fossa tumors surgically treated in Xuanwu Hospital between Sep. 2013 and Aug. 2018 were analyzed retrospectively. Of them, endoscopic endonasal approach(EEA) was adopted in 105, transcervical approach in 26 and transfacial approach in 23. Results Preoperative assessments included routine blood tests, computerized tomography(CT) scan and enhanced magnetic resonance imaging(MRI) of skull base. Preoperative digital subtraction angiography(DSA) was accomplished in 32 cases. Intraoperative blood transfusion was required in 37, and prophylactic tracheotomy in the 5 patients with transcervical approach. Cerebrospinal fluid(CSF) leak occurred in 4 cases and got cured by conservative treatment and dressing change without intracranial infection. Two patients had posterior epistaxis from sphenopalatine artery or internal maxillary artery and got cured with surgical hemostasis. One patient with EEA had postoperative internal carotid artery vasospasm and cerebral infarction which was improved after treatment including anti-vasospasms, corticosteroid and brain protective agents.Conclusion The perioperative management for surgical resection of infratemporal fossa tumors includes preoperative assessments, intraoperative blood transfusion, as well as the diagnosis and treatment of complications. Proper and prompt perioperative management is crucial to patients’ early recovery.

关 键 词：颞下窝肿瘤 围手术期 手术入路 

分 类 号：R739.91[医药卫生—肿瘤]