额鼻瓣及鼻锥翻转切除累及颅底的鼻腔鼻窦肿瘤

Tumors of Nasal Cavity and Paranasal Sinuses Invading the Skull Base Removel by Frontal Musculocutaneous Flap and the Nasal Pyramid Overturn

目的探讨彻底切除累及颅底的鼻腔、鼻窦肿瘤的手术进路。方法采用额鼻瓣和鼻锥翻转的方法彻底切除累及颅底的鼻腔鼻窦肿瘤25例,其中肿瘤侵犯前颅底12例,侵犯中颅底5例,同时侵犯前中颅底8例。内镜及手术显微镜辅助手术,肌筋膜修补颅底缺损。结果良性肿瘤彻底切除,恶性肿瘤中随访3年以上者21例,其中3年存活率61.9%(13/21),5年存活率38.9%(7/18),术后发生脑脊液漏4例,经保守治疗痊愈,无1例发生严重颅脑并发症。结论额鼻瓣及鼻锥翻转的方法彻底切除累及颅底的鼻腔鼻窦肿瘤是可行的方法。

Purpose To study an approach to remove the tumors of nasal cavity and paranasal sinuses invading the skull base or intracranial tissue. Methods The frontal musculocutaneous flap was over-turned upward and the nasal pyramid was over-turned to the healthy side to achieve an enough visual field. Among the 25 cases,anterior skull base was involved in 12,middle skuli base was involved in 5, and both anterior and middle skull bases were involved in 8. In some of them. endoscope and microscope were used, and muscular fascia was used to repair the defected skull base. Results 3-year survival rate was 61.9%(13/21) ,5-year survival rate was 38.9% (7/18), and all benign tumore were removed thoroughly. Cerebrospinal fluid leak was cured in all 4 cases, and there was not any other serious complication. Conclusion The frontal musculocutaneous flap overturn and the nasal pyramid overturn was an effective approach to remove the tumors of nasal cavity and paranasal sinuses invading the skull base or intracranial tissue.