鞍区不同部位肿瘤的手术入路与显露程度分级

Classification of surgical exposures for different tumors involving different parts of sellar region

经不同手术入路，显微外科技术切除鞍区不同部位及不同类型肿瘤６３例。按术中是否需要脑牵拉与脑组织的直观反应，将手术显露程度分四级：Ⅰ级１９例（３．０％），毋须脑牵拉即能显露肿瘤并予以切除；Ⅱ级３８例（６０％），术中对脑间断性略加牵拉，但去牵拉后，脑局部外观与未牵拉部无异；Ⅲ级３例（５％），牵拉处脑组织出现伤痕；Ⅳ级３例（５％），术野脑损伤较明显或呈不同程度之肿胀。良好的显露在相当程度上有赖于适当的手术入路与显微外科技术的有机结合及术者的技术熟练程度。作者认为本显露程度分级可作为衡量颅底肿瘤手术方法是否合理的一项指标。

Abstract The surgical exposures were classified as 4 grades according to the observation of operations on 63 consecutive patients with different tumors involving different parts of sellar region. Grade Ⅰ (n = 19):It was unnecessary to retract brain tissue during removal of the tumors;Grade Ⅱ(n = 38):with a very little of cerebral retraction but no damage was grossly found to the brain after tumor removal;Grade Ⅲ(n = 3):slight injury was brought to the brain surface beneath the self-retaining retractor; Grade Ⅳ (n = 3):It was found obvious to have brain damage or cerebral swelling of different degrees, owing to brain retraction or disturbance of brain venous drainase. 73. 7% of graded Ⅰ were observed in the cases operated on via the combined fronto-temporal-orbito-zygomatic approach. The authors believe that this classification may be used as one of the indexes for evaluating the rationality of the operative approach in skull base surgery.