颅面复发肿瘤外科治疗

Surgical treatment of craniofacial recurrent carcinoma

目的 经放射治疗、化学治疗或手术后复发的颅面晚期恶性肿瘤往往因病变范围广泛 ,累及颅脑和神经、血管等重要结构 ,手术切除困难 ,或又因对放射治疗或化学治疗不敏感而使患者得不到有效治疗 ,为了改善这类患者的生存质量 ,预防致死性并发症 ,延长其生命而行手术治疗。方法根据 6例这类病例的病变部位、范围和性质行非定型手术切除 ,并酌情进行颅底和脑膜重建和修复 ,包括使用前额带蒂肌皮瓣、颅骨骨板和阔筋膜等。结果 6例这类患者其病变均侵犯眼、脑膜、脑组织、海绵窦、颅底或其它重要神经血管等结构 ,1例术后半年因颈内动脉破裂大出血死亡 ,5例存活 1年以上 ,其中 3例分别存活 4、5和 12年。结论 对这类晚期复发肿瘤采用非定型手术 (nondefinedoperation)切除 ,只要方法得当是可以延长患者生命 ,为颅面晚期复发肿瘤的治疗取得初步有益经验。

Objective The patients with craniofacial recurrent cancers after the radiation, chemical and operative therapies were often not able to get effective treatment because their lesions involved in the nervous and vascular structure and the re-radiation therapy was not suitable or chemical therapy was not sensitive to the tumor as well. To improve their survival quality, prevent the fatal complication and prolong their life, the surgical treatment for them was advised. Method Six patients were treated surgically. According to the lesion of extension and position, the different incisions were respectively made. The neoplasms of these patients were resected piece by piece because they usually involved in the important structures, such as the internal carotid artery and cavernous sinus. Then, local defect was repaired with different methods on basis of the individual condition. So, this type of operation could be called as non-defined operation. Results The lesions in all 6 patients invaded the eye, meninges and encephala, skull base, cavernous sinus and other important structures. After surgical intervene, the patients were all more than one year survival except for one of the patients who died of serous bleeding with corrupted rupture of internal carotid artery. Three patients survived for 4, 5 and 12 years, respectively. Conclusion The craniofacial recurrent carcinomas in late stage could be resected by the non-defined operation, which could prolong the patients life and achieve the desired effect.