侧颅底受侵或侧颅底相关头颈部恶性肿瘤的手术治疗

An Analysis of Operation for Lateral Skull Base Involved or Related Head and Neck Malignancies

[目的]探讨侧颅底受侵或侧颅底相关头颈部恶性肿瘤的理想手术入路及其手术效果。[方法]1998年12月至2008年2月,对50例侧颅底受侵或侧颅底相关头颈部恶性肿瘤进行手术治疗。采用颈下颌进路20例、颞下窝入路22例、上颌骨外翻入路1例、颅面联合入路6例、Weber-Ferguson加Lynch入路1例。[结果]全组50例,49例达裸眼肿瘤全部切除,无手术死亡,术后暂时性偏瘫1例,术后脑脊液漏1例。随访满3年有34例,3年总生存率61.76%,无瘤生存率58.82%。[结论]侧颅底受侵或侧颅底相关头颈部恶性肿瘤的手术入路应视肿瘤部位而定,手术风险可以接受。手术治疗有望改善患者的生存质量并延长患者的生命。

[Purpose ] To explore optimal surgical approach for lateral skull base involved or related head and neck malignancies and its surgical efficacy. [Methods] From December 1998 to February 2008, 50 cases with lateral skull base involved or related head and neck malignancies underwent operation and the surgical approaches included transcervical transmandibular approach, 20 cases; transinfratemporal approach, 22 cases; maxillary swing technique, 1 case; skull-face combined approaches, 6 cases; Weber-Ferguson and Lynch, 1 case. [Results] The tumors were naked eye viewed perfectly resected in 49 cases without operative death. There were postoperative cerebrospinal fluid leak in 1 case and postoperative transient hemiplegia in 1 case. Thirty-four cases followed-up for 3 years. The 3-year overall survival and progress free survival rate were 61.76% and 58.82%, respectively. [Conclusions] The surgical approach for lateral skull base involved or related head and neck malignancies should base the site of tumor and the surgical risk is acceptable. Quality of life and survival prolonged might be improved from surgical treatment.