内镜经鼻切除旁中央颅底硬膜外胆脂瘤手术的疗效分析  

Effect analysis on endoscopic transnasal resection of epidural cholesteatoma at paracentral skull base

作　　者：何京川[1] 马越[2] 黄振华[2] 翟翔[1] 于焕新[1] 张金玲[1] 张强[1] 刘钢[1] He Jingchuan;Ma Yue;Huang Zhenhua;Zhai Xiang;Yu Huanxin;Zhang Jinling;Zhang Qiang;Liu Gang(Department of Otorhinolaryngology Head and Neck Surgery,Tianjin Huanhu Hospital,Tianjin 300350,China;Department of Neurosurgery,Tianjin Huanhu Hospital,Tianjin 300350,China)

机构地区：[1]天津市环湖医院耳鼻咽喉头颈外科,300350 [2]天津市环湖医院神经外科,300350

出　　处：《中华耳鼻咽喉头颈外科杂志》2021年第9期951-955,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：天津市卫生健康科技人才培育项目(KJ20168)。

摘　　要：目的总结内镜经鼻切除旁中央颅底硬膜外胆脂瘤手术的临床特点,并分析其手术疗效。方法回顾性分析2017年8月至2020年8月在天津市环湖医院采用内镜经鼻手术治疗的7例旁中央颅底硬膜外胆脂瘤患者的临床资料,其中男性4例,女性3例,年龄32~63岁。所有患者均采用内镜经鼻手术,观察术中切除情况、术后并发症及治疗效果。所有患者术后随访6~36个月,记录患者术后复查头颅MRI、临床症状恢复及复发情况。采用描述性统计学方法进行分析。结果7例患者中,4例实现完全切除(囊内容物和囊壁完全切除),1例实现近全切除(囊内容物完全切除,部分囊壁残留),2例实现次全切除(部分囊内容物、囊壁残留)。1例患者术前无明显临床症状,其他6例患者术后症状均得到缓解。1例患者出现术后脑脊液鼻漏,经腰大池引流及鼻腔碘仿纱条填塞治疗后治愈。术后随访至今,包括非全切除患者在内的7例患者均无肿瘤复发。结论对于旁中央颅底生长范围局限的硬膜外胆脂瘤,内镜经鼻手术治疗方法简单有效,安全可靠,并发症较少。Objective To indicate the clinical features of endoscopic transnasal resection of epidural cholesteatoma at paracentral skull base and to analyze its efficacy.Methods The total excision rate,postoperative complications and postoperative curative effect of 7 patients(4 males and 3 females,aging from 32 to 63 years old)who underwent middle skull base surgery for epidural cholesteatoma resection under transnasal endoscope at Tianjin Huanhu Hospital between August 2017 and August 2020 were retrospectively reviewed.All patients were followed up for 6 to 36 months.The postoperative MRI,clinical symptoms and recurrence were reviewed.Descriptive statistical methods were used for analysis.Results Among the 7 patients,there were total resection(complete resection of cyst contents and capsule)in 4 patients,near-total resection(complete resection of cyst contents,incomplete resection of cyst capsule)in 1 patient,and subtotal resection(incomplete resection of cyst contents and capsule)in 2 patients.The clinical symptoms of all patients were improved postoperatively with 1 patient who had no clinical symptoms.One case had postoperative cerebrospinal fluid rhinorrhea,which was cured after lumbar drainage and nasal iodoform gauge packing.Up to now,7 patients(including patients with partial resection)had no recurrence.Conclusion Endoscopic transnasal approaches may be effectively used for resection of epidural cholesteatoma in the paracentral skull base in carefully selected cases.

关 键 词：自然腔道内镜手术 耳鼻喉外科手术 旁中央颅底 胆脂瘤 

分 类 号：R739.41[医药卫生—肿瘤]