上颌外旋及下颌外旋切除前中颅底、咽、咽旁间隙肿瘤的手术研究

Maxillary swing and mandibullar swing approach for resection of anterior, middle skull base, pharynx and parapharyngeal space tumors

目的 :探讨彻底切除前中颅底、咽、咽旁间隙肿瘤的理想手术入路。方法 :采用不同部位的上颌外旋入路切除 16例前、中颅底肿瘤 ,此 16例肿瘤均累及多区 ,范围广泛 ;采用下颌外旋入路治疗 2 6例鼻咽、口咽、咽旁及颅底肿瘤。结果 :16例上颌外旋术后随访 2～ 5年 ,生存 4年以上 3例 ,3年以上 6例 ,2年以上 6例 ,术后 1.5月死亡 1例。 2 6例下颌外旋术后随访 18个月～ 6年 ,4例良性肿瘤情况良好 ,无复发 ,2 2例恶性肿瘤中 ,2例 0 .5年内死亡 ,2例 1年余复发 ,1例术后 2年死于肺部转移 ,4例存活 5年以上 ,6例存活 4年以上 ,3例存活 3年以上 ,3例存活 2年以上 ,1例存活 1年以上。大部分病例仍在继续随访中。结论 :上颌外旋及下颌外旋入路是彻底切除前中颅底、咽、咽旁间隙肿瘤理想。

Objective:To seek for a better approach for the resection of anterior, middle skull base, pharynx and parapharyngeal space tumors. Methods: 16 neoplasmas involving the anterior and middle skull base were removed respectively using the various part of maxillary swing and its extention or/and its combinations. All 26 cases of pharyngeal, parapharyngeal space and skull base tumors were thoroughly resected via mandibullar swing approach. Results:All 16 cases of maxillary swing patients were followed up from 2 to 5 years. 3 survived for more than 4 years,6 for 3 years, 6 for 2 years, one died at 1 month.All 26 cases of mandibullar swing patients were followed up from 18 months to 6 years,4 cases with benign tumors had been living well without relapse. In the malignant group, 2 died at 6 months, 2 died at 1 year, one died of lung metastasis at 2 years. 4 survived for more than 5 years, 6 for 4 years, 3 for 3 years, 3 for 2 years, 1 for 1 year. Conclusion: These procedures provide good exposure of the anterior, middle skull base, pharyngeal and parapharyngeal space, and are safe with minimal morbidity.