经额纹切口眶上锁孔入路切除前颅底及鞍区肿瘤的临床分析  

Clinical analysis of supraorbital keyhole approach via a forehead wrinkle incision for resection of tumors in anterior skull base and sellar region

作　　者：杨驰 王建标 杨思明 洪文明[1] 王斌[1] Yang Chi;Wang Jianbiao;Yang Siming;Hong Wenming;Wang Bin(Department of Neurosurgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230000,China)

机构地区：[1]安徽医科大学第一附属医院神经外科,合肥230000

出　　处：《中华神经外科杂志》2021年第5期449-453,共5页Chinese Journal of Neurosurgery

基　　金：安徽省自然科学基金(1908085QH379)。

摘　　要：目的探讨经额纹切口眶上锁孔入路切除前颅底及鞍区肿瘤的临床疗效。方法回顾性分析2017年1月至2020年2月安徽医科大学第一附属医院神经外科采用经额纹切口眶上锁孔入路切除62例前颅底及鞍区肿瘤患者的临床资料。患者术前均行头颅MRI平扫+增强检查诊断为前颅底或鞍区肿瘤,其中脑膜瘤49例(包括嗅沟脑膜瘤24例、鞍结节脑膜瘤18例、蝶骨嵴脑膜瘤7例),颅咽管瘤8例,垂体腺瘤5例。根据肿瘤的大小和生长偏向个体化地设计皮肤切口及骨瓣位置。术后根据影像学资料及临床症状评估肿瘤的全切除率及并发症的发生情况,同时调查患者对切口美观程度的满意度。术后定期行影像学及临床随访,以观察肿瘤是否复发和患者的预后情况。结果62例患者中,肿瘤全切除54例(87.1%),次全切除8例(12.9%),无手术相关死亡病例。62例肿瘤术后均经病理学检查确诊。术后头痛症状的改善率为85.7%(24/28),视力下降的改善比例为13/14,嗅觉症状的改善比例为13/15,眩晕症状的改善比例为5/6,肢体麻木、行走不稳的改善比例为4/5。患者对切口美观程度的满意度为87.1%(54/62)。62例患者均获得随访,随访时间为(18.0±5.6)个月(1~36个月),随访期间无死亡患者;4例(6.4%)术后出现前额麻木、眶上感觉迟钝的患者,3个月随访时症状消失或好转;2例(3.2%)垂体腺瘤复发,接受二次手术治疗后未见复发。结论经额纹切口眶上锁孔入路切除前颅底及鞍区肿瘤,不仅可以提供足够的手术视野、获得满意的肿瘤切除程度,而且可以明显改善患者的临床症状。Objective To investigate the clinical efficacy of supraorbital keyhole approach via a forehead wrinkle incision in resection of tumors in anterior skull base and sellar region.Methods A retrospective study was conducted on the clinical data of 62 patients with tumors located in anterior skull base and sellar region who underwent surgery through supraorbital keyhole approach via a forehead wrinkle incision at Neurosurgery Department of the First Affiliated Hospital of Anhui Medical University from January 2017 to February 2020.All patients underwent MRI plain scan and enhanced scan before operation,including 49 cases of meningioma(24 cases of olfactory groove meningioma,18 cases of tuberculum sellae meningioma and 7 cases of sphenoid ridge meningioma),8 cases of craniopharyngioma and 5 cases of pituitary adenoma.According to the size and growth of tumor,skin incision and bone flap position were designed individually.Postoperative imaging data and clinical symptoms were used to evaluate the total resection rate and the incidence of complications,and the satisfaction of patients with regard to the aesthetic of forehead wrinkle incision was investigated.The tumor recurrence rate and survival rate were followed up 3 months after operation.Results Among the 62 patients,total resection was achieved in 54 cases(87.1%)and subtotal resection in 8 cases(12.9%).There was no surgical death.All 62 cases were confirmed by pathological examination.The improvement rate of headache,visual acuity,olfactory symptoms,vertigo,numbness and walking instability was 85.7%(24/28),13/14,13/15,5/6,4/5;the patients with satisfaction with regard to the aesthetic of forehead wrinkle incision accounted for 87.1%(54/62).All 62 patients were followed up for 18.0±5.6 months(1-36 months).No patients died during the follow-up period,the survival rate was 100%,The dumbness of forehead and supraorbital area occurred in 4 cases post operation relieved or disappeared at 3 months follow-up.2(3.2%)cases of pituitary adenoma recurred,and no recurrence was

关 键 词：颅底肿瘤 显微外科手术 治疗结果 额纹切口 锁孔手术 

分 类 号：R739.41[医药卫生—肿瘤]