颅底近颅底肿瘤的手术入路选择

Surgical Approach for Skull Base and Near Skull Base Tumors

目的探讨切除颅底、近颅底部肿瘤时最佳的手术入路。方法随机选取该院颅脑外科2007年12月—2008年12月期间行颅底、近颅底肿瘤切除手术的患者86例。回顾性分析其手术治疗,通过11种手术路径分别对患者进行外科治疗,为患者完全切除累及翼腭窝、颞下窝、鼻咽部、鼻窦、颅底等部发热肿瘤。结果患者经手术后均实现了肿瘤的彻底切除,术后并发脑脊液漏者6例,皆在6 d内自愈完全,未见其他严重的颅脑并发症且无手术死亡病例。86例颅底、近颅底肿瘤患者中,良性肿瘤32例,随访至今患者情况良好,其中生存时间>5年的有21例,术后5年生存率65.63%(21/32),目前生存期最长>9年(1例)。恶性肿瘤54例,均获取了随访,患者的3年生存率为61.11%(33/54)、5年生存率为41.38%(12/29)。结论对不同的颅底、近颅底肿瘤患者施以不同的手术路径进行肿瘤的切除,结果令人满意,可提升患者整体的生存质量,值得在临床上进行推广。

Objective This paper tries to explore the best surgical approach to resect the skull base and near the skull base tumor.Methods A total of 86 patients treated the skull base and near the skull base tumor resection were random selected from December 2007 to December 2008.To retrospectively analyze of its surgical treatment,through 11 kinds of surgical pathways for surgical treatment of patients,patients involving the pterygopalatine fossa,infratemporal fossa,nasopharynx,nasal sinus,skull base fever and other parts of the tumor were completely removed.Results All patients underwent complete resection of the tumor after operation.6 patients had cerebrospinal fluid leakage after operation,all of which were completely self-healing within 6 days.No other serious craniocerebral complications were found and no surgical death was found.Totally 86 patients with skull base and near skull base tumors had benign tumors in 32 cases.The patients were followed up so far in good condition.Among them,21 cases survived>5 years and 65.63%(21/32).The longest period>9 years(1 case).54 patients with malignant tumor were followed up.The 3-year survival rate was 61.11%(33/54)and the 5-year survival rate was 41.38%(12/29).Conclusion Different skull base and near skull base tumor patients with different surgical path for tumor resection can improve the overall quality of life of patients.The results are satisfactory.And it is worth to be promoted in clinical practice.