颅底与近颅底区肿瘤的手术治疗

SURGICAL THERAPY OF TUMORS OF THE SKULL BASE AND THE NEAR SKULL BASE (WITH A REPORT OF 88 CASES)

目的:总结颅底与近颅底区肿瘤的手术治疗效果。方法:前颅底区肿瘤58倒(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等三种进路切除;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,前颅底区恶性肿瘤三年生存率为64%,五年生存率为46.8%;侧颅底区恶性肿瘤三年生存率为46.7%,五年生存率为26.6%, 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方式, 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 summarize the surgical method and its therapeutic effect on patients with tumors of the skull base and the near skull base.Method: Fifty-eight cases of the anterior skull base tumors, of which 8 cases were benign and 50 cases were malignant, were resected by nasal bone move approach and combined with frontal windowing approach, 12 cases benign tumors of lateral skull base were removed by mastoidectomy and lateral neck incision approach and 15 cases malignant tumors of lateral skull base were resected by subtotal resection of temporal bone approach - lateral neck incision approach, middle skull fossa approach and infratemporal fossa - lateral neck incision - inferior maxilla out - turned approach; three cases of benign tumor of the nasopharyngeal rigion were removed by nasal cavity-maxillary sinus and soft palate incision approach. Results: Twenty' three benign tumors followed up respectively for 1 year and 3 years postoperatiely, there are one case relapse, which was received another operation, other cases without evidence of recurrense. Of the malignant tumors of anterior skull base, the three - year survival rate was 64 % (32/50) and the five-year survival rate was 46.8% (22/47) .Of the malignant tumors of lateral skull base, the three - year survival rate was46.7% (7/15) and the five-year survival rate was26.7% (4/15) . The low long term effect may be related to the late stage of many cases of this group. Conclusion: It showed that to choice the surgical approach based on the position, range and pathological type of the tumor could provide a good exposure of surgical field, to resect the tumor completely, to improve therapy effect, and to reduce complication.