扩大鼻外额窦进路切除前颅底肿瘤术式探讨

Resection tumor of the anterior skull base region with extend external frontal sinus approach

目的:探讨前颅底额眶筛区肿瘤切除的最佳手术入路。方法:采用扩大鼻外额窦进路术式对28例累及前颅底额眶筛区的肿瘤患者行肿瘤切除术。结果:经随访,8例良性肿瘤至今无复发或死亡,20例恶性肿瘤中,1年生存率95.0%(19/20),3年生存率61.5%(8/13),5年生存率57.1%(4/7)。结论:该术式术野暴露充分,手术时首先自前颅底剥离肿瘤阻断瘤体在颅底的血供,出血少,手术视野清晰,操作便捷,切除肿瘤彻底,重建颅底方便,手术创伤小,术后反应轻。该术式是切除前颅底额眶筛区肿瘤的较好手术入路。

Objective：To study a better surgical approach for the resection of tumor in the anterior skull base and the fronto-orbito-ethmoidal region. Method： Extend external frontal sinus approach was made in the lesion side. The incision can be extended outward to the nasal side or superciliary arch according to the tumors extent and size so as to get a full exposure of tumors of anterior skull base, fronto-orbito-ethmoidal region, or exterior margin of arcula. Result：From January 1998 to December 2003, 28 patients suffered tumors of anterior skull base and fronto orbito-ethmoidal region were received tumors resection through this approach. Postoperatively, no death or recurrence have occurred up to now in 8 cases of benign tumors, and the one-year survival rate was 95 % （19/20）, the three-year survival rate was 61.5% （8/13）,and the five-year survival rate was 57.1% （4/7） in 20 cases of malignant tumors. Conclusion：This approach provide good exposure. Beleeding is little,operation field is clear, operating is easy re-establish skull base is convenience, surgical trauma is small, and reaction is mild when using decohesion tumors and block blood supply in skull base method. We believe this approach is a better method for resection of tumors in anterior skull base and the fronto-orbito-ethmoidal region.