口腔颌面部癌瘤的颅底手术评价

EVALUATION OF THE CRANIOBASIS OPERATION FOR ORAL AND MAXILLOFACIAL MALIGNANT TUMOUR

口腔颌面部癌瘤侵及颅底者,临床虽较为少见,但诊断、治疗均较困难,手术方法也有争议,很有探讨的必要。本文报告16例,男性12例,女性4例,平均年龄39岁。手术方法有:保守性手术,根治性手术和功能性手术。文章讨论了三点:(1)颅底解剖的分区,本文提出仿照颅内底部解剖的前、中、后三个自然区域,应用划线法将颅底外部,分成与之相对应的前、中、后三个区域,有助于比较熟悉的颅内分区来认识颅底外部。能以此法来指导颅内外结合手术,既有利于更彻底的切除肿瘤,也可增加手术的安全性。(2)术式的选择,即是主动进颅,被动进颅和未曾进颅(颅底下手术)。是按照肿瘤性质,瘤体大小,侵袭范围,与术前检查,以及术者对癌瘤手术认识决定的,这术式的选择与预后无明显的相关性。(3)安全边缘的掌握:三种术式实际是安全边缘的宽与窄的问题,与手术安全性,并发症有着密切关系,在当代外科手术注重功能,讲究生存质量的前提下,供临床选择应用。

It is necessary to discuss the craiobasis operation in the treatment of malignant tumour in oral and Maxillofacial invaded base of skull although it is rare in clinic. 16 cases were reported in this paper, involved male 12, female 4 and the average age is 39 years. Method: conservative operation, radical operation and functional operation. The author discussed three points: 1, A ccording to cranioto pography divided base of skull into anteriority, centricity and posteriority regions. This mathod used in operation is profit eradicating the tumour and increasing the safety in operation. 2. Selection of method is related to the tumour properties, size, range of invasion, antioperation and knowedge of operater, no related to the prognosis. 3. Selection safety and complication. It is necessary to consider the function in the clinical working.