鼻内镜经鼻入路手术治疗颅底脊索瘤

Endoscopic transnasal approach for surgical treatment of skull base chordomas

目的:探讨鼻内镜经鼻入路手术治疗颅底脊索瘤的手术方法,临床效果。方法:2002年5月-2006年12月收治9例颅底脊索瘤病人,运用鼻内镜经鼻入路切除蝶骨斜坡区脊索瘤,7例肿瘤未能全切除者术后辅以埋置放射性粒子(125I)进行内照射,帮助杀灭残余的肿瘤组织。结果:肿瘤全切除2例,次全切除4例,部分切除3例,无手术后并发症。9例患者术后随访,平均18个月。正常生活工作6例,生活自理3例。术后6例患者头痛消失,3例头痛减轻。结论:鼻内镜经鼻入路最适宜切除病变主要位于中、上斜坡,肿瘤大部在硬膜外、生长到鼻窦、鼻腔鼻咽部的肿瘤。鼻内镜经蝶入路手术治疗颅底脊索瘤是一种安全、有效、创伤小、容易操作、省时的手术入路,疗效满意。

Objective：To discuss the surgical methods and clinical effect of endoscopic transnasal approach to resect chordoma of skull base. Methods： Nine cases with skull base chordoma were admitted to our department from May 2002 to December 2006 . Endoscopic transnasal approach was taken to resect the chordoma of the sphenoid bone and clivus. 7 patients whose tumor couldnt be removed totally were implanted irradiational particle 125 I in order to kill the residual tumourous tissue. Results： Total resection was performed in 2 cases, subtotal resection in 4, partial resection in 3; No complications were occurred postoperation. 9 cases were followed up for 18 months（mean） , 5 cases retured to normal life , 4 cases cared by oneself, headache disappeared in 6 cases, relieved in 3 cases after operation. Conclusion： Endoscopic transnasal approach is adapted to resect chordoma of middle and upper clivus and those lesions involving nasal cavity, nasal sinuses and nasopharynx. Endoscopic transnasal approach has many advantages, such as safety, efficiency, minimal invasion, simple manipulation, timesaving, good results.