112例侧颅底肿瘤术后并发症的预防和处理

Prevention and management of postoperative complications in 112 patients with lateral skull base surgeries for tumors

目的回顾性研究侧颅底肿瘤术后并发症,探索术前、术中的预防和术后的处理方法。方法分析2001年1月至2006年7月112例行侧颅底肿瘤切除术的病例资料,肿瘤类型包括神经鞘膜瘤、胆脂瘤、复发性鼻咽癌、副神经节瘤、脑膜瘤等;主要手术径路包括扩大迷路、耳蜗、颞下窝、乙状窦后、颅中窝径路、颞骨径路等。结果112例侧颅底肿瘤全切率为97.32%。术后最常见的并发症是脑脊液漏,共出现8例(7.14%),其中仅1例(0.89%)需要手术修补,由脑脊液漏造成颅内感染者2例(1.79%)。死亡3例(2.68%),死因分别为颅内出血、术后脑梗死和术后窒息各1例。脑水肿4例(3.57%),术后失语、急性肺水肿及肺部感染、腹壁皮下血肿各1例(0.89%),后组颅神经麻痹失代偿2例(1.79%)。结论术前对肿瘤的正确诊断和对患者全身状况的正确评估、手术径路的正确选择和娴熟掌握、术中彻底止血、术后严密观察和细致护理,可提高手术切除侧颅底肿瘤的安全性,降低术后并发症的发生率。

Objective To study the incidence, prevention and management of postoperative complications in lateral skull base surgeries for tumors. Methods The data of 112 patients who underwent surgical removal of lateral skull base tumors from January 2001 to July 2006 were collected and analysed. The lateral skull base tumors included neurinoma, cholesteatoma, recurrent nasopharyngeal carcinoma, glomus paraganglioma and meningioma, and the major surgical approachs were enlarged translabyrinthine approach, transcochlear approach, infratemporal fossa approach, retrosigmoid approach, middle fossa approach and transtemporal approach. Results The rate of complete resection was 97.32%. The most frequent complication was cerebrospinal fluid （CSF） leak, which occurred in 8 patients （7.14%） , and only 1 （0.89%） of them needed revision surgery. Other complications included meningitis caused by CSF leak in 2 cases （1.79%）, cerebral edema in 4 cases （ 3.57% ） , lower cranial palsy in 2 cases （ 1.79% ） , acute pulmonary edema and pulmonary infection in 1 case （0.89%）, and subcutaneous abdominal hematoma in 1 case （0.89%）. There occurred three cases of death （2.68%）, cause of which were intracranial hemorrhage, cerebral infarction and asphyxia, respectively. Conclusion The accurate diagnosis for the tumors and correct evaluation of the patients＇ general conditions, in combination with the proper surgical approachs, rigorous hemostasis and comprehensive postoperative management may lead to less incidence of postoperative complications in lateral skull base surgeries for tumors.