经鼻内镜切除良性鼻-颅底肿瘤(附11例报告)

Transnasal Endoscopic Resection for Benign Nasal Skull-base Neoplasms: Report of 11 Cases

目的探讨鼻内镜下切除良性鼻-颅底肿瘤的疗效。方法 2004年3月～2009年11月对11例良性鼻-颅底肿瘤,鼻内镜下先切除鼻腔鼻窦肿瘤,逐渐接近颅底,仔细辨认颈内动脉等重要解剖结构,然后分块切除肿瘤,最后修复颅底缺损。结果 11例鼻-颅底肿瘤鼻内镜下全部切除,术中出血量100～450 ml,平均175 ml;手术时间105～210 min,平均146 min。术后未出现脑脊液鼻漏、细菌性脑膜炎等并发症。病理类型:巨大筛额窦囊肿2例,鼻咽纤维血管瘤3例,上颌窦内翻性乳头状瘤3例,蝶窦骨化纤维瘤1例,翼腭窝神经鞘瘤1例,侧颅底炎性肌母细胞瘤1例。11例随访6～58个月,平均41个月,鼻窦CT扫描和鼻内镜复查无肿瘤局部复发。结论鼻内镜手术利于辨别颅底重要的解剖结构和肿瘤的彻底切除,是治疗鼻-颅底良性肿瘤的理想方法。

Objective To explore the curative effect of transnasal endoscopic resection（TER） for nasal skull-base neoplasms.Methods Totally 11 cases with benign lesions in the skull base received surgical treatment in our hospital from March 2004 to November 2009.We first removed the nasal neoplasms with TER,approached to the skull base,carefully identified the internal carotid artery and other important anatomical structures,and then removed the block skull base neoplasms,finally repaired the skull base defects.Results The tumors focus of the 11 cases were completely resected.The average intraoperative blood loss was 175 ml（100-450）,and mean operation time was 146 minutes（105-210）.Postoperative cerebrospinal fluid（CSF） leakage and acute bacterial meningitis did not occur in this series.Pathological examination confirmed 2 cases of huge ethmoidal-frontal sinus cyst,3 nasopharyngeal fibroangioma,3 maxillar sinus inerted papilloma,1 sphenoid sinus osteofibroma,1 schwannomas in the pterygopalatina fossa,and 1 inflammatory myoblastomyoma in the lateral skull base.The patients were followed up for a mean of 41 months（6-58）,during which,no one died,no recurrence was detected by CT or nasoscopy.Conclusion TER is an ideal treatment for nasal skull-based neoplasms,for it is easier to recognize important anatomical structures and completely remove the neoplasm by using nasoscopy.