颅底恶性肿瘤术后组织缺损Ⅰ期修复重建

A study on the first stage reconstruction of tissue defect after skull base tissue resection.

目的 探讨颅底区手术后骨及软组织缺损的 期修复重建方法。方法 对 38例颅底恶性肿瘤患者 ,手术切除所致颅底软硬组织缺损进行了 期修复。修复材料主要为带蒂斜方肌下部岛状肌皮瓣 8例 ,带蒂胸大肌下部岛状肌皮瓣 5例 ,带蒂颞肌复合组织瓣或带蒂颞肌筋膜帽状腱膜瓣 +骨块 +游离皮片共 17例 ,额肌复合组织瓣 7例 ,前臂皮瓣血管吻合游离移植 1例。组织瓣面积 8cm× 10 cm～ 7cm× 2 5 cm。结果 组织瓣成活率 89.47% (34/ 38例 ) ,术后并发症率18.4% (7/ 38例 ) ,其中肌皮瓣部分坏死 10 .5 % (4 / 38) ,脑脊液漏 5 .2 % (2 / 38) ,颅内感染 2 .6 % (1/ 38例 ) ,均经对症治疗后痊愈。结论 颅底组织缺损采用显微外科技术 期修复重建能够有效地预防严重的手术后并发症 ,尤以带血管蒂组织瓣转位移植术修复重建颅底区组织缺损的方法具有组织瓣存活率高 ,易掌握和可靠性强等优点 ,可做颅底区修复重建的首选方法。

Objective To study the methodology of StageⅠ reconstruction for bony and soft fissue defect after skull base surgery.Methods Thirty-eight cases of defect of the skull base were affended.The skull base had been destroyed by malignant tumor in all the patients.The tissues were reconstructed in the operation immediately.The island musculocutaneous flap of the lower trapezius,the island pectoralis major myocutaeous flap,the temporlis muscle compound flap,and the frontal muscle compound flap were adopted.Results The cure rate was 89.47%.In 4 (10.5%)cases,necrosis was found in some parts of the musculocutaneous flap.Two (5.2%)patients with CSF leak and 1(2.6%) patient with infection were recovered after treatment.Conclusion With the use of micrurgic technigues,the first stage reconstruction for tissue defect after skull base surgery is an effective method for preventing the serious postoperative complications.