经鼻内镜颅底进路手术的探索  

Exploration of transnasal endoscopic cranialbase approach

作　　者：许庚[1] 李源[1] 谢民强[1] 文卫平[1] 史剑波[1] 陈合新[1] 吕剑霆[1] 张革化[1] 刘贤[1] 徐睿[1] 

机构地区：[1]中山大学附属第三医院耳鼻咽喉科,广州510630

出　　处：《中华耳鼻咽喉科杂志》2002年第6期443-446,I003,共5页Chinese Journal of Otorhinolaryngology

基　　金：国家自然科学基金委国家杰出青年基金项目( 3972 5 0 2 5 )

摘　　要：目的　探讨经鼻内镜颅底进路手术的可行性和适应证范围。方法　分别采用经鼻内镜前颅底进路和蝶窦后上壁进路完成前颅窝异物取出术、前颅窝嗅神经母细胞瘤和脑膜瘤切除术、侵入前颅窝的鼻腔内翻性乳头状瘤切除术、侵入中颅窝的巨大蝶窦囊肿切除术、原发性中颅窝鞍旁岩尖部胆脂瘤切除术、侵入鞍区的占位性病变切除术共 9例。结果　 9例手术均获成功 ,未发生术中和术后并发症。除 1例低分化鳞癌鞍区占位性病变术后 2年死于其他非相关性疾病外 ,另外良性 ( 5例 )和恶性 ( 3例 )占位性病变随访 1～ 7年未见复发。结论　紧靠颅底的颅内占位性病变有经鼻内镜手术的可能性 ,但是适应证选择应非常严格 ,术者必须具备熟练的解剖学知识、手术技巧和经验 ,并配备先进的手术设备。对范围局限的恶性病变 。Objective To study feasibility and indication of cranialbase surgery by transnasal endoscopic approach. Methods Nine cases treated by transnasal were analyed. Those cases included foreign body, olfactory neuroblastoma,meningoma and inverted papilloma in anterior cranial fossa, sinuses sphenoidalis macrosis cyst invading middle cranial fossa, primary cholesteatoma and space occupying lesion in middle cranial fossa. Result The complications were not occurred in all cases. Follow-up survey 1～7 years, no-relapse was occurred. Conclusion It is probability that surgery lesion be close skull base by transnasal endoscopic approach, but indication must be exactitude selected. The operator should be have firm anatomic,skilled operation and richness experience. The malignancy lesion should be compositive treatment after surgery.

关 键 词：鼻内镜 颅底进路手术 前颅窝异物取出术 前颅窝嗅神经母细胞瘤 脑膜瘤 外科手术 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]