中颅底肿瘤的手术治疗

Surgical treatment in middle skull base tumors

目的探讨优选中颅底肿瘤手术入路。方法对132例中颅底肿瘤分别进行相应的手术切除。上颌骨外旋及扩大外旋或合并颞下入路切除6例,经颈下颌外旋切除16例,经颈入路切除48例,经腮入路5例,经口入路7例,经腭合并Denker或唇龈切开切除鼻咽纤维血管瘤26例,颞耳前颞下入路4例,颞额入路9例,经鼻内镜切除垂体瘤11例。结果 113例良性肿瘤7例复发,复发率6.2%,复发者经再次手术均治愈;19例恶性肿瘤,无术中死亡病例,3年存活率76.9%,5年存活率40%。结论上颌外旋及扩大外旋能充分的显露前、中颅底肿瘤;经颈下颌骨外旋能良好的显露咽,咽旁间隙,颞下窝,蝶骨,斜坡及上颈椎;经颈入路适于切除咽旁间隙良性或中下区早期恶性肿瘤;额颞入路适于切除颞下窝肿瘤;经腭入路最适于I、II期鼻咽纤维血管瘤的切除,合并Denker或唇龈切开适切除III期肿瘤;鼻内镜适于切除颅底中线部位病变,如垂体瘤,应根据病变的特点选择合适的手术入路及手术方法。

OBJECTIVE Optimize surgical approach of middle skull base tumors.METHODS 132 middle skull base tumors were resected by different approaches.There were maxillary approach and extended maxillary swing approach with infratemporal fossa approaches in 6 cases, transcervical mandibular fossa swing approach in 16 cases, transcervical approaches in 48 cases, transparotid in 5 cases transoral in 7 cases, transpalatine or with Denker or glngival-labial incision in 26 cases, subtemporal preauricular infratemporal fossa approach in 4 cases, transfronta-temporal in 9 cases and transendoscope in 11 cases.RESULTS In the 113 benign cases, there were 7 recurrence, rucurrence rate about 6.2%. All recurrence cases were reoperated and got good result. In the 19 malignant cases, no dead during operation period. The 3 and 5 year survival rates were 76.9%and 40% respectively. CONCLUSION The various maxillary swing approaches provide maxium exposure of the anterior and middle skull base tumors.The transcervical mandibular swing provides good exposure of the pharyne, parapharyngeal space infratemporal fossa, sphenoid, clivus and upper cervical vertebra. The transcervical approach suite to benign or early malignant tumors of parapharyngeal space. The frontemporal approach suite to infratemporal fossa tumors.The subtemporal-preauricular infratemporal approach suit for tumors involving the petrous bone and middle or low clivus.The transpalatine approach suit for stage Ⅰ-Ⅱ or with Denker or gingival labial incision for some stage Ⅲ nasopharyngeal angiofibroma.Nasoendoscope suite for microinvasively removal of the mideline of skull base, such as the pituitary tumors and surrunding lesions. Suitable approach and suitable method should be chosen for different people.