摘要
目的探讨在对前颅底肿瘤实施显微手术时,手术入路的选择和颅底重建的原则。方法回顾性总结前颅底肿瘤患者85例的临床资料。借助术前影像学(CT和MR)资料,准确评估肿瘤的部位、大小、性质和周边组织受累情况等,从而选择合理且熟悉的手术入路。术中尽可能在显微镜辅助下对肿瘤进行微创切除,降低术后致残率和病死率。并根据肿瘤切除后颅底结构的缺损程度决定相关的修复方案。结果85例患者中经冠状开颅(包括半冠)入路的26例。经改良翼点入路的38例,经额眶入路的13例,经额、鼻窦联合入路的9例。肿瘤镜下全切除的79例,次全切除4例,部分切除2例。术后有83例患者的临床症状获得不同程度的缓解,无手术死亡病例。13例患者的肿瘤发生远期复发,其病理性质以恶性为主。所有颅底脑膜缺损的患者匀在一期重建,采用自体肌腱膜或人工脑膜加生物胶进行严密修复。对小于3cm的颅底骨质缺损一般不实施重建,有5例患者的骨性缺损大于3cm,采用了人工材料(硅橡胶为主)进行重建。全部患者中有4例在术后发生短暂的脑脊液漏,均通过保守治疗而愈合。结论根据肿瘤的大小、部位和周边组织的受累情况选择适当的入路,对肿瘤患者实施微创切除并在一期进行必要的颅底修复是治疗前颅底肿瘤的有效方法。手术入路应尽量有利于病灶切除,并降低术后致残率和病死率,颅底重建时必须恢复硬脑膜的严密性,维持颅底组织的良好支撑,同时不干扰对肿瘤的术后复查和辅助治疗。
Objective To analyze the choice of surgical approach and the reconstruction principle of skull base for microsurgery of anterior skull base tumors. Methods Eighty - five cases with anterior skull base tumors treated surgically at Cancer Center between July 2000 to August 2007 were analyzed retrospectively. According to the data of CT/MR scan, we evaluated the characteristics of the tumors pre -operatively as accurately as possible and selected the practical and favorite surgical approach. Most operations were performed under microscope to reduce mortality and mutilation. Results Tumors were removed totally in 79 cases, sub - totally in 4 cases, and partially in 2 cases. The clinical symptoms of most patients were remitted. No surgical death occurred. Thirteen patients with malignant tumors had recurrence later. All meningeal membrance defections were repaired during tumor removal. In our view, reconstruction of cranial bone was unnecessary for defection less than 3cm in diameters. Temporary CSF leakage occurred in 4 patients post - operatively. All the CSF leakages were cured by conservative methods. Conclusion Minimal invasive mierosurgery is the best way to treat skull base tumor. The surgical approach in favor of tumor removal and minimizing mortality and mutilation should be considered according to the characteristics of tumor. The meningeal membrance barrier must be completely reconstructed, while some small skull defection is unnecessary to repair without significant consequence.
出处
《广东医学》
CAS
CSCD
北大核心
2008年第1期6-8,共3页
Guangdong Medical Journal
基金
华南肿瘤学国家重点实验室基金资助(编号:985Ⅱ)
关键词
前颅底肿瘤
颅底重建
外科手术
Anterior skull base tumor
Surgical treatment
Reconstruction of skull base