内镜下经口鼻联合入路手术切除颅底脊索瘤

Endoscopic resection of skull base chordoma via the combined oral and nasal approach

目的总结内镜下经口鼻联合入路手术切除颅底脊索瘤的疗效及安全性。方法回顾分析2008年12月至2022年12月首都医科大学宣武医院收治的192例颅底脊索瘤患者临床资料和随访数据,根据肿瘤切除程度、临床症状缓解、手术相关并发症发生率及预后评价手术疗效,Kaplan⁃Meier法行生存分析。结果内镜下经口鼻联合入路行颅底脊索瘤切除术,80.21%(154/192)达到影像学全切除(全切除组)、19.79%(38/192)存在影像学残留(残留组)。围手术期死亡2例,术后并发症包括脑脊液漏[6.77%(13/192)]、新发脑神经功能障碍[6.25%(12/192)]、蛛网膜下腔出血[2.08%(4/192)]和颅内耐药菌感染[1.56%(3/192)]。随访81(52,120)个月,死亡57例;全切除组中位生存时间为7.41年、残留组4.33年,两组生存时间差异具有统计学意义(χ2=23.018,P=0.002)。结论内镜下经口鼻联合入路手术可有效切除颅底脊索瘤,患者生存时间延长、预后良好;手术全切除肿瘤是预测预后的重要指标。

Objective To summarize the efficacy and safety of endoscopic resection of skull base chordoma via the combined oral and nasal approach.Methods The clinical data and follow⁃up data of 192 patients with skull base chordoma admitted to the Department of Otorhinolaryngology,Head and Neck Surgery,Xuanwu Hospital,Capital Medical University from December 2008 to December 2022 were retrospectively analyzed.The surgical efficacy was evaluated according to the degree of tumor resection,the emission of clinical symptoms,the incidence of postoperative complications,and the prognosis.Kaplan⁃Meier was used for survival analysis.Results All patients underwent endoscopic resection of skull base chordoma via the combined oral and nasal approach.Among the 192 patients,80.21%(154/192)achieved imaging total resection(gross total resection group)and 19.79%(38/192)with residual imaging(residual group).Two patients died during perioperative period.Postoperative complications included cerebrospinal fluid leakage[6.77%(13/192)],new nerves dysfunction[6.25%(12/192)],subarachnoid hemorrhage[2.08%(4/192)]and intracranial infection[1.56%(3/192)].Follow up of 81(52,120)months resulted in 57 deaths.The median survival time in the gross total resection group was 7.41 years,while in the residual group it was 4.33 years.The difference in survival time between the 2 groups was statistically significant(χ2=23.018,P=0.002).Conclusions Endoscopic combined oral and nasal approach can effectively remove skull base chordoma,prolong survival time,and have a good prognosis.Surgical gross total resection of tumors is an important indicator for predicting prognosis.