摘要
目的总结颅底与累及颅底区肿瘤的手术治疗效果。方法前颅底区肿瘤58例(良性8例,恶性50例)采用鼻骨移位进路前颅底大块切除和附加前额开窗,颅面联合切除;侧颅底区肿瘤27例(良性12例,恶性15例),良性肿瘤采用乳突切除进路和颈侧切开进路切除,恶性肿瘤分别采用颞骨次全切除高位颈侧切开进路、颅中窝进路和颞下窝颈侧切开下颌骨外旋联合进路三种进路切除;鼻咽部3例巨大良性肿瘤,采用鼻腔上颌窦与软腭切开进路切除。结果23例良性肿瘤经1～3年随访,除1例术后复发行再次手术切除外,其余均无复发。65例恶性肿瘤经5年以上随访。50例前颅底区恶性肿瘤3年生存率为64%,5年生存率为46.8%;15例侧颅底区恶性肿瘤3年生存率为46.7%,5年生存率为26.7%。远期疗效较低与本组多为晚期病例有关。结论本组病例根据肿瘤发生的部位、侵犯范围和病理类型所采用的手术进路,能充分暴露病变,有利于肿瘤的切除,从而取得了较好的治疗效果,未发生严重并发症。
Objective To report the surgical approaches and the therapeutic effect on patients with tumors at the skull base and its adjacent area. Methods 58 patients with anterior skull base tumors, of which 8 cases were benign and 50 were malignant, were operated on by means of nasal hone displacement combined with frontal fenestration; tumors were resected totally. Of the 27 patients with lateral skull base tumors, 12 benign tumors were removed by mastoidectomy and lateral neck incision approach, and 15 malignant tumors of lateral skull base were removed by subtotal resection of temporal hone combined with lateral-superior neck incision, middle skull fossa approach, and infratemporal fossa-lateral neck incision combined with maxilla outward rotated approach respectively. Three nasopharyngeal benign tumors were removed via nasal cavity-maxillary sinus and soft palate incision approach. Results 23 patients with benign tumors were followed up for 1 -3 years after the operation; only one case was recured with another operation. In patients with malignant tumors of anterior skull base, the three-year survival rate was 64% （32/50） and the five-year survival rate 46.8% （22/47）. In patients with malignant tumors of lateral skull base, the three-year survival rate was 46.7% （7/15） and the five-year survival rate 26.7% （4/15）. The lower long-term effect may result from the late tumor stage in many cases. Conclusion The surgical approach should be based on location, size, and pathological type of the tumors. It should provide a good exposure in order to remove the tumor totally, to keep away from serious complications and to abtain a good prognosis.
出处
《中国耳鼻咽喉颅底外科杂志》
CAS
2005年第4期246-249,共4页
Chinese Journal of Otorhinolaryngology-skull Base Surgery
