颅鼻眶联合入路切除筛窦恶性肿瘤

Trans-cranio-naso-orbital approach in treatment of ethmoid sinus malignant tumors :analysis of 39 cases

目的总结经颅鼻眶入路治疗筛窦恶性肿瘤的临床经验。方法回顾性分析39例经颅鼻眶入路手术切除侵犯前颅凹及眼眶的筛窦恶性肿瘤的临床资料。39例中男29例,女10例,年龄20～65岁,平均42岁;肿瘤类型包括嗅母细胞瘤10例、腺癌8例、鳞癌7例、乳头状瘤6例、肉瘤4例、未分化癌3例、基底细胞癌1例。38例肿瘤侵犯前颅凹,其中31例侵犯眼眶、5例侵犯翼腭窝、3例侵犯中颅凹及海绵窦。临床表现包括鼻堵、鼻溢、鼻衄、鼻部肿物,突眼、视力下降,面部麻木,意识障碍等。结果肿瘤全切除32例(其中包括9例完整摘除),近全切除7例。术后一过性脑脊液鼻漏5例,无颅内及切口感染。随访到27例(77.1%),随访时间为3个月至7年,平均3年6个月。肿瘤局部复发8例,肺部转移1例。术后1个月至6年死亡4例。结论经颅鼻眶入路充分显露侵犯前颅凹及眼眶部的筛窦肿瘤,且能完整切除肿瘤,手术安全,并发症少。

Objective To summarize the experience in treatment of ethmoid sinus malignant tumors via trans-cranio-naso-orbital approach. Post-operationally follow-up was conducted in 27 cases for 3.5 years （3 months to 7 years）. Methods The clinical data of 39 patients with ethmoid sinus malignant tumors, 25 males and 14 females, aged 42 （20-65）, with the chief complaints of nasal airway obstruction, rhinorrhagia, nasal neoplasm, exophthalmos, decreased vision, facial numbness, disturbance of consciousness, etc, who underwent resection of tumor via trans-cranio-naso-orbital approach retrospectively. Pre-operational MR showed that the tumor invaded the anterior cranial fossa in 38 cases, invading the orbit in 31 cases, invaded the pterygnpalatine fessa in 5 cases, invaded the middle cranial fessa and cavernous sinus in 3 cases. Results Tumor total removal was achieved in 32 cases （ including removal ea bloc in 9 cases）, and subtotal removal in 7 cases. Pathological examination diagnosed 10 cases as with olfactory neuroblastoma, 8 cases with edenocarinoma, 7 cases with squamous cell carcinoma, 6 cases with pallioma carcinoma, 4 cases with unclassified sarcoma, 3 cases with undifferentiated carcinoma, and 1 case with schneiderian carcinoma. Postoperatively, temperal CSF leak was found in 5 cases. There was no intracranial or wound infection. Local recurrence was found in 8 cases, 1 case had lung metastasis, and 4 cases died 1 month to 6 years postoperatively. Condusion Adequate exposure of the ethmoid sinus tumor involving the anterior cranial fossa and orbit can be obtained via suitable trans-cranio-naso-orbital approach, and by this approach the tumor can be removed en bloc. This approach is relatively safe and with few complications.