累及侧颅底肿瘤手术切口的临床分析

Clinical analysis of surgical incisions for tumors involving lateral skull base

目的:探讨安全切除累及侧颅底的肿瘤的手术切口及其疗效。方法 :选择2008年8月—2015年8月收治的21例累及侧颅底的肿瘤患者,良性肿瘤13例,恶性肿瘤8例。其中5例采用头皮半冠状切口,8例采用改良FergusonWeber切口,7例采用耳前-下颌下切口,1例采用头皮半冠状-耳前-下颌下-改良Ferguson-Weber复合切口。结果 :20例患者的肿瘤均完整切除,1例上颌窦纤维肉瘤复发患者行姑息切除。所有手术患者均未出现围术期死亡及严重术中、术后并发症。8例恶性肿瘤中,5例术后予以放疗,3例术后予以化疗。恶性肿瘤患者术后3年生存率为50%(4/8)。结论 :对于累及侧颅底的肿瘤,应针对其所侵及的具体解剖结构,选择最适宜的手术切口。其中头皮半冠状切口、改良Ferguson-Weber切口、耳前-下颌下切口与复合切口较为常用,且均可达到手术目的,但又各有其侧重点。

PURPOSE： To investigate the surgical procedures and treatment effects for complete and safe resection of tumors involving lateral skull base. METHODS： Twenty-one patients with tumors involving lateral skull base were treated in our department from August 2008 to August 2015. Eight cases were diagnosed as malignant tumors by pathological examinations. Five cases underwent surgery through scalp hemicoronal-anterior auricular incision, eight cases underwent operation through modified Ferguson-Weber incision, seven cases underwent operation through anterior auricular-inframandibular incision, and combined incision was used in 1 patient. RESULTS： Only 1 patient with recurrent fibrosarcoma of the maxillary sinus underwent palliative resection and 20 patients underwent radical resection. No deaths and serious complications were found during perioperative period. In 8 patients with malignant tumors, five received postoperative radiotherapy and 3 underwent postoperative chemotherapy. 3-year survival rate of patients with malignant tumors was 50%（4/8）. CONCLUSIONS： Appropriate operation access should be adopted based on anatomical structures.Scalp hemicoronal-anterior auricular, modified Ferguson-Weber, anterior auricular-inframandibular and combined incisions are more commonly used surgical approaches, but with different indications.