经鼻内镜切除旁中线颅底良性病变的手术入路选择  

Surgical approach of transnasal endoscopic resection of benign lesions in the paramedian lateral skull base

作　　者：李海艳[1] 翟翔[1] 何京川[1] 张金玲[1] 刘钢[1] LI Haiyan;ZHAI Xiang;HE Jingchuan;ZHANG Jinling;LIU Gang(Department of Otolaryngology Head and Neck Surgery,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,天津300350

出　　处：《临床耳鼻咽喉头颈外科杂志》2022年第5期352-356,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨经鼻内镜切除旁中线颅底良性病变的手术入路。方法:回顾性分析2018年8月—2021年2月采用经鼻内镜手术治疗的40例旁中线颅底良性病变患者的临床资料,其中胆脂瘤9例,血管瘤6例,血管外皮细胞瘤1例,神经鞘膜瘤6例,蝶窦外侧隐窝脑膜脑膨出伴脑脊液鼻漏15例,鼻咽癌放疗后骨炎3例。所有患者行经鼻内镜手术切除,根据病变位置选择不同的手术入路。结果:40例患者病变全切,全切率为100%。1例术后出现脑脊液鼻漏,经修补后治愈。随访3~30个月,39例患者术后有不同程度的上颌部或下颌部麻木感,2周~6个月麻木感消失;1例神经鞘膜瘤患者术后1年仍遗留一侧上唇麻木。结论:经鼻内镜切除旁中线颅底良性病变手术安全性及治愈率较高。手术入路的选择主要以翼突为中心点向周围扩展,根据病变位置选择径路最短、损伤最小的入路,同时也要根据术者擅长术式选择内镜手术入路。Objective:To investigate the surgical approach of transnasal endoscopic resection of benign lesions in the paramedian lateral skull base.Methods:Retrospectively analyze 40 cases of the clinical data of patients with benign lesions of the skull base from August 2018 to February 2021 with transnasal endoscopic surgery,including 9 cases of cholesteatoma,6 cases of hemangioma,1 case of hemangiopericytoma,6 cases of schwannoma,15 cases of sphenoid sinus lateral crypt meningocele and cerebrospinal fluid leak,3 cases of nasopharyngeal carcinoma bone inflammation after radiotherapy.All patients underwent transnasal endoscopic surgery,and different surgical approaches were selected according to the lesion location.Results:The total resection rate was 100%in 40 patients.One patient had cerebrospinal fluid rhinorrhea,which was cured after repair.During the follow-up period of 3-30 months,39 patients had different degrees of numbness in the maxillary or mandibular region,and the numbness disappeared from 2 weeks to 6 months;one patient with schwannoma still had numbness on one side of the upper lip one year after surgery.Conclusion:Transnasal endoscopic resection of benign lesions in the paramedian skull base has a high surgical safety and cure rate.The surgical approach selection mainly focuses on the pterygoid process and extends to the periphery.The shortest and least damaging approach should be selected according to the lesion location,and the endoscopic approach should also be selected according to the surgeon’s expertise.

关 键 词：鼻内镜手术 翼突入路 旁中线颅底 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]