鼻内镜微创手术治疗鼻颅底肿瘤36例临床分析

Management of nasal skull-base neoplasms with endoscopic minimally invasive technique： a report of 36 cases

目的探讨鼻内镜微创外科技术应用于鼻颅底肿瘤的适应证、疗效及安全性。方法回顾性分析2000年1月至2004年6月鼻内镜下行鼻颅底肿瘤切除术36例，其中鼻咽血管纤维瘤16例、鼻窦骨化纤维瘤8例、垂体瘤8例、嗅神经母细胞瘤4例。患者术后均行病理检查证实。鼻咽血管纤维瘤患者术前行供血动脉介入栓塞术；嗅神经母细胞瘤患者术后给予放疗；2例较大的垂体瘤患者手术未能完全切除，术后给予放疗。结果36例患者均行肿瘤全部或者大部分切除。3例患者出现脑脊液鼻漏并发症，其中2例分别采用中鼻甲黏膜和肌肉组织修补成功，另1例仅给予降颅压、抗炎处理后自愈。术后随访4～8年均无复发。结论在正确选择适应证的前提下，鼻内镜微创手术能够安全有效地处理鼻颅底肿瘤。

Objective To discuss the indication, efficacy and safety of endoscopic minimally invasive surgery technique in the management of nasal skull-base neoplasms. Methods Thirty-six patients with nasal skull base neoplasms were treated from January 2000 to Jun 2004 under nasal endoscopy, including 16 nasopharyngeal fibroangioma, 8 sinus osteofibroma, 8 pituitary adenoma, 4 olfactory neuroblastoma. Pathology lab procedures were performed pre or post-operatively. The feeding artery of nasopharyngeal fibroangioma was selectively embolized with gelatin sponge before operation. All olfactory neuroblastoma and 2 pituitary adenoma received radiotherapy after operation. Results Total or most of nasopharyngeal fibroangioma, sinus osteofibroma, olfactory neuroblastoma and pituitary adenoma were excised. Three cases presented complications of cerebrospinal fluid leakage, 2 cases were successfully mended with middle turbinate and muscle tissue respectively, another one gained self-healing after reducing the intracranial pressure and anti-inflammation. Followed up 4 to 8 years without recurrence for all patients. Seldom serious complications accured. Conclusions When the indications are selected appropriately, nasal skull-base neoplasms, including benign and malignant, can be well treated with nasal endoscopic minimally invasive surgery.