不栓塞条件下经鼻内镜手术治疗侵犯颈内动脉颅底肿瘤的应用  

Application of transnasal endoscopic surgery for tumours of the skull base invading the internal carotid artery without embolisation conditions

作　　者：王再兴 张秋航 曾宪海 卢永田 WAGN Zaixing;ZHANG Qiuhang;ZENG Xianhai;LU Yongtian(Shantou University Medical College,Shantou 515041,China;Department of Otorhinolaryngology,Shenzhen Longgang Otorhinolaryngology Hospital/Shenzhen Institute of Otolaryngology,Shenzhen 518172,China;Department of Otorhinolaryngology,The Second People's Hospital of Shenzhen/The First Affiliated Hospital of Shenzhen University,Shenzhen 518035,China)

机构地区：[1]汕头大学医学院,广东汕头515041 [2]深圳市龙岗区耳鼻咽喉医院耳鼻咽喉科/深圳市耳鼻咽喉研究所,广东深圳518172 [3]深圳市第二人民医院/深圳大学第一附属医院耳鼻咽喉科,广东深圳518035

出　　处：《汕头大学医学院学报》2024年第2期90-94,共5页Journal of Shantou University Medical College

基　　金：深圳市医学重点学科建设(SZXK039)。

摘　　要：目的:探讨不行颈内动脉栓塞条件下经鼻内镜手术切除侵犯颈内动脉颅底肿瘤的应用价值。方法:回顾性收集2018年1月—2021年12月就诊于深圳市龙岗区耳鼻咽喉医院的经鼻内镜手术切除侵犯颈内动脉的颅底肿瘤患者的病历资料及影像学资料。共纳入了30例患者,其中男性17例,女性13例,年龄22~74(51±13)岁,随访时间2~64个月(中位随访时间18个月)。分析患者的肿瘤类型、侵犯颈内动脉部位、影像学、颈内动脉处理策略及预后等资料。结果:30例患者中,有28例患者球囊闭塞试验阴性,其中1例放射性颅底骨坏死患者进行了颈内动脉栓塞,其他患者未进行颈内动脉栓塞。所有患者均接受了鼻内镜下颅底病变切除术,术中根治性切除了颅底病变,同时很好地保护了颈内动脉,均未出现颈内动脉破裂出血。随访期间29例(96.7%)患者生存,26例(86.7%)患者术后病情稳定,无进展。结论:不行颈内动脉栓塞条件下经鼻内镜手术切除侵犯颈内动脉的颅底肿瘤安全可行,术前进行球囊闭塞试验可指导手术方案的制定,提高手术疗效及安全性。Objective:To investigate the value of transnasal endoscopic surgical resection of skull base tumours invading the internal carotid artery under conditions of no internal carotid artery embolisation.Methods:The medical records and imaging data of patients with skull base tumours invading the internal carotid artery who underwent transnasal endoscopic surgical resection at Shenzhen Longgang Otorhinolaryngology Hospital from January 2018 to December 2021 were retrospectively collected.A total of 30 patients,including 17 males and 13 females,aged 22-74(51±13)years,with a follow-up time of 2-64 months(median time 18 months),were included.The patients were analyzed for information on tumour type,site of invasion of the internal carotid artery,imaging,internal carotid artery management strategy and prognosis.Results:Balloon occlusion test was negative in 28 out of 30 patients.One patient with radiological skull base osteonecrosis underwent internal carotid artery embolisation,while the others did not undergo internal carotid artery embolisation.All patients underwent nasal endoscopic resection of the skull base lesion,in which the skull base lesion was radically resected while the internal carotid artery was well protected,and none of them suffered from rupture of the internal carotid artery and bleeding.Twenty-nine(96.7%)patients survived during the follow-up period,and 26(86.7%)patients were stable and progression-free after surgery.Conclusion:Transnasal endoscopic surgical resection of skull base tumours invading the internal carotid artery without internal carotid artery embolisation is safe and feasible,and preoperative balloon occlusion test can guide the development of surgical protocols and improve surgical efficacy and safety.

关 键 词：颅底肿瘤 球囊闭塞试验 鼻内镜手术 颈内动脉栓塞 

分 类 号：R739.4[医药卫生—肿瘤]