鼻腔鼻窦占位性病变累及颅底的手术处理

Surgical Treatment of Space-occupying Lesions in the Nasal Cavity and Paranasal Sinus Involving the Skull Base

报告２９例鼻腔、鼻窦占位性病变累及颅底的病例。其中良性病变１２例。恶性病变１７例。经鼻侧进路手术１７例，颅鼻联合进路６例，上颌骨截除并眶内容剜出３例，经额和经面中部揭翻入路各１例，还有１例行颈廓清后干颈外动脉插管作区域性化疗。其中有１８例行颅底骨缺损修复。修复材料为自体筛骨垂直板、犁骨、鼻中隔软骨、中鼻甲和额骨或额窦内板。１４例脑膜修补，修补材料为自体肌肉、筋膜和帽状健膜等，除１例因手术进路选择不当术后发生脑脊液漏外，其余病例未发生术后并发症。重点讨论了这类病例的手术进路选择、颅底和脑膜缺损修复方法等。

This paper reports 29 cases of space-occuping letsions in the naxal cavities and the paranasal sinuses,Of them,12 were benign and 17 malignant.They were all surgically treated,17 by lateral rhinotomy,6 by combined cranio-nasal approaches,3 by maxillectomy and evisceration of the orbit,1 hy transfrontal and 1 by midfacial degloving approaches,respectively. The regional chemother- apy was administered to a case via external carotid artery after neck dissection,Among these cases,18 of the skull defects were rehabilitated.The repairing materials included the autoiogous perpendicular plate of the ethmoid bone,the vomer,the septal cartilage,the middle turbinate and the internal laminae of the frontal bone or sinus. The meningeal defects in 14 cases were repaired using autologous muscle. fascia,galea aponeurotica,Except for one case of postoperative cerebrospinal rhinorrhea due to improper surgical approach,no cases had postoperative complications.