颅面联合进路切除颅底恶性肿瘤16例临床总结

Craniofacial Surgery for Malignant Tumor of Skull Base-Clinical Review of 16 Cases

近年来,颅底肿瘤手术有较快的发展。为积累和交流经验,本文总结了16例颅底恶性肿瘤病例,探讨手术径路和治疗效果。方法:回顾性分析1985年至今在中山大学肿瘤防治中心采用颅面联合径路切除的16例颅底恶性肿瘤病例资料,探讨手术径路、修复方法,总结生存、复发情况及并发症。结果:16例中前颅底手术12例(13次手术,其中1例两次前颅底手术),侧颅底3例,后颅底1例。6例硬脑膜切除后用额骨骨膜、颞肌筋膜、阔筋膜和人造硬脑膜修复,颅底缺损3例用钛网、1例用玻璃钢,其它只用额骨骨膜和/或帽状腱膜和/或肌肉修复,皮肤缺损3例用带血管蒂皮瓣、2例用转移皮瓣修复。颅底手术后生存时间为1～99个月,中位生存时间为14个月。8例术后复发,复发的中位时间为20个月,4例术后未控,4例无瘤生存。7例出现较轻微的并发症。结论:根据肿瘤位置选择前、侧、后颅底手术径路进行颅面联合手术可以安全和有效地切除肿瘤,同时配合术后放疗可以获得较好的效果。

OBJECTIVE & BACKGROUND: A number of advancement in craniofacial surgery was achieved in the last decade. The aim of this article was to investigate the surgical approaches and effectiveness of craniofacial surgery by analyzing data of 16 patients. METHODS: Surgical approaches, reconstruction methods, survival and recur-rent status and complications of sixteen patients with malignant tumors in the skull base treated in Cancer Center of Sun Yat-sen University from 1985 to 2003 were analyzed retrospectively. RESULTS: The 16 patients underwent 17 craniofa-cial operations, of which,13,3 and 1 operation were done in the area of anterior, medial and posterior skull base respective-ly. The defects of the dura mater in six cases were repaired by pericranium, fascia temporalis, fascia lata or artificial tis-sue, respectively. The titanium mesh and artificial tissue were used in some cases to reconstruct the bony defect in the skull base. In the other cases the bone defects were reconstructed by the pericranium and/or galeal-pericranial flap and/or muscle alone. The skin defects were repaired by pedicled free flap and locoregional flap for 3 and 2 patients respec-tively. Survival time ranged from 1 to 99 months and the medial survival time was 14 months. Eight cases recurred and the median recurrent time was 20 months, 4 cases were uncontrolled and another 4 cases still survived with no tumor recur- rence. Only seven cases suffered from complica-tions and most of them were mild and tolerable.CONCLUSION: The craniofacial surgery for malig-nant tumors in the skull base was safe and effec-tive as long as the rational surgical approaches were chosen according to the tumor site.