不同颞下窝进路联合技术切除侧颅底病变  

Surgery technique of combined different infratemporal fossa approaches for lesions in lateral skull base

作　　者：魏兴梅 高志强[1] 许志勤[2] 杨华[1] 张竹花[3] 田旭[1] 赵杨[1] 周娅琳 冯国栋 Wei Xingmei;Gao Zhiqiang;Xu Zhiqin;Yang Hua;Zhang Zhuhua;Tian Xu;Zhao Yang;Zhou Yalin;Feng Guodong'(Department of Otorhinolaryngology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Neurosurgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China;Operating room,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and.Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院耳鼻咽喉科,100730 [2]中国医学科学院北京协和医学院北京协和医院神经外科,100730 [3]中国医学科学院北京协和医学院北京协和医院影像科,100730 [4]中国医学科学院北京协和医学院北京协和医院手术室,100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2020年第9期814-821,共8页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：北京市科学技术委员会重点基金(Z191100007619040);首都卫生发展科研专项(CFH2020-2Z-40115)。

摘　　要：目的通过总结颞下窝联合进路(combined infratemporal approach,CIFA)切除颅底病变的临床效果,探讨其技术要点和临床应用价值。方法回顾性分析2014年12月至2018年7月在北京协和医院耳鼻咽喉科因颅底肿物行CIFA切除病变的11例患者的临床资料。其中男性6例,女性5例;年龄16~71岁,中位年龄53岁。其中5例患者采用CIFA Type B+D切除病变,6例采用CIFA Type A+B切除病变。术后定期复查颞骨增强MRI判断有无肿瘤复发。结果5例采用CIFA Type B+D术式的患者中3例为颞骨巨细胞修复性肉芽肿,2例为颞骨骨巨细胞瘤,肿瘤最大横截面的中位数为42 mm×46 mm(范围37 mm×18 mm^56 mm×53 mm);6例采用CIFA Type A+B术式的患者中4例为头颈部副神经节瘤,1例为颅底神经鞘瘤,1例为岩尖胆脂瘤,肿瘤最大横截面的中位数为43 mm×36 mm(范围24 mm×22 mm^63 mm×35 mm)。11例患者中9例一期手术完整切除肿瘤,2种术式中各有1例分二期切除病变(一期切除颅外部分,二期切除侵入颅内的部分)。CIFA Type B+D组中有1例重建了鼓室和听力,术后1年听力为轻度传导性听力下降。所有患者术后均未发生脑脊液漏。术前面神经功能正常的5例患者,术后面神经功能均在3个月内恢复到House-Brackmann分级(H-B)Ⅰ~Ⅱ级;术前面神经功能为Ⅱ级的4例患者,术后有2例恢复为Ⅰ级,另外2例仍为Ⅱ级;1例术前面神经功能为Ⅲ级的患者由于术中切除面神经术后面神经功能为Ⅵ级,1例术前面神经功能为Ⅴ级的患者,术后恢复为Ⅲ级。2例术前已有耳蜗破坏,术中予以切除,其余9例均保留了耳蜗。术后随访14~58个月,均未见病变复发。结论CIFA技术可以安全、彻底切除广泛侵犯侧颅底的占位病变,术中及术后耳蜗、面神经功能得到较好的保护与恢复。灵活运用CIFA技术,不仅可以实现病变的良好暴露和完整切除,还可为功能重建创造条件。Objective:To investigate the technical points and clinical application of combined infratemporal fossa approaches(CIFA)by analyzing the clinical results with CIFA for lesions involved skull base.Methods:A retrospective study was performed on 11 patients underwent CIFA for skull base lesions dissection from December 2014 to January 2019 in the department of otolaryngology,Peking Union Medical College Hospital.There were 6 male and 5 female patients,with age range of 16-72 years old and median age of 53 years old.Five patients underwent CIFA Type B and D,and the other 6 underwent CIFA A and B.All patients were followed up regularly by CT and MRI to observe possible recurrence.Results:Among the 5 patients with CIFA Type B and D,3 were giant cell tumor and 2 were giant cell reparative granuloma,and median maximum cross-section size was 42 mm×46 mm(range from 37 mm×18 mm to 56 mm×53 mm).Among the 6 patients with CIFA Type A and B,4 were paraganglioma of head and neck,1 was schwannoma of skull base,1 was petrous cholesteatoma,and median maximum cross-section size was 43 mm×36 mm(range from 24 mm×22 mm to 63 mm×35 mm).Nine patients underwent complete resection of the tumor in the first stage.In 2 patients,the extracranial parts were removed in the first stage,and the intracranial part was removed in the second stage.Tympanum and ossicular reconstruction were done in one of the CIFA Type B and group D,and 1 year′s postoperative hearing was mild conductive hearing loss.There was no cerebrospinal fluid leakage of all patients.All the 5 patients with normal facial nerve function before surgery recovered to H-B gradeⅠtoⅡwithin 3 months after surgery.Among the 4 patients whose preoperative facial nerve function were gradeⅡ,2 recovered to grade I after surgery and the other 2 were still gradeⅡ.For the patient whose preoperative facial nerve function was gradeⅤ,his postoperative recovery was gradeⅢ.There was 1 patient whose pre-operative FN function was H-B gradeⅢ,and the post-operative FN function was gra

关 键 词：颅底肿瘤 耳外科手术 联合颞下窝进路 

分 类 号：R739.41[医药卫生—肿瘤]