摘要
目的 :探讨完整切除中耳侧颅底区巨大肿瘤以及同期修复术腔缺损的手术途径。方法 :采用两种术式 :( 1 )耳颈联合“Y”形切口 ,将耳郭向上翻揭 ,以处理腮腺、颈上深淋巴结 ;( 2 )耳内外联合倒“U”形切口 ,将耳郭向下翻转 ,以处理上鼓室乳突天盖、颅中窝底区病变。结果 :1 5例术中视野暴露充分 ,肿瘤均能一次大块完整切除 ,并同期用邻近自体带蒂肌瓣修补颅底 ,术后切口一期愈合。 3年存活率为 80 % ( 1 2 1 5) ,随访满 5年者 7例占 46 6%。结论 :采用外耳翻揭径路 ,术中视野暴露充分 ,便于完整大块切除肿瘤并同期修补侧颅底 ,术后并发症少 ,可及早进行放射治疗。
Objective:To totally resect the enormous tumors of the middle ear and the lateral skull base and repair the surgical space simultaneously under well exposure of the tumors.Method:Two overturn approaches of the external ear were adopted:(1)“Y”form auriculocervical incision,the auricle was overturned upward so as to treat the parotid gland and the superior lymphoglandulae cervicales profundae;(2)Inverse “U” form joint incision from inside and outside of the ear,the auricle was overturned downwards so as to remove the tumors in the regions of the tegmen tympani and the fossa cranii media.Results:All tumors of the 15 cases were removed totally under well exposure and the skull bases were repaired simultaneously with the adjacent muscular flaps with pedunculus, and the incisions were healed by first intention.Of the 15 cases,12 cases had survived for 3 years(80%),7 cases had been followed up for 5 years(46.6%).Conclusion:Through overturn approach,the external ear is easily to be removed the tumor totally under well exposure of the tumor,to be repaired the lateral skull base simultaneously,and to be given complemental radio-therapy earlier with little complication.
关键词
耳肿瘤
外科手术
外耳翻揭
Ear neoplasms
Surgery,operative
External ear overturn
