面部移位入路手术切除颅底肿瘤的颅底修补与重建(附38例报告)

目的探讨采用上颌骨翻转面部移位入路手术切除侵及颅底肿瘤的颅底修补与重建。方法38例颅底侵入瘤患者,均采用上颌骨翻转面部移位入路手术切除,颅底缺损采用9种不同方法修补。结果38例患者均达到显微镜下肿瘤全切或次全切。全部患者获1~70个月随访,平均随访33.7个月。因肿瘤复发死亡6例,与肿瘤无关死亡2例,带瘤生存5例,其余25例均无肿瘤复发。与颅底修补与重建有关的手术并发症包括:转移组织瓣部分坏死2例,脑脊液漏3例,1例术后第30天行面部创腔冲洗吸引时突发颈内动脉大出血死亡。结论上颌骨翻转面部移位入路手术切除颅底侵入瘤具有显露充分、肿瘤切除彻底的优点。根据肿瘤切除后颅底缺损情况采用不同的方法修补,重建颅底,疗效满意。

Repair and reconstruction of skull base after surgical removal of skull base tumors via transmaxillary approach(Report of 38 cases)

Objective To study the repair and reconstruction of skull base after surgical removal of skull base tumors via transmaxillary approach.Methods Defects of skull base in 38 patients suffering from skull base tumors surgically removed via transmaxillary approach were repaired and reconstructed with 9 different methods.Results The microscopic total or subtotal removal of tumors were achieved in all patients.All patients were followed up from 1 to 70 months(mean duration=33.7 months).6 cases die of recurrence,and 2 died of other diseases.5 cases were alive with tumor and 25 cases were alive without recurrence.The surgical complications included partial necrosis of repair tissue(2 cases),leakages of cerebrospinal fluid(3 cases).One patient died at the 30th postoperative day because of rupture of internal cervical artery during draining and suction of craniofacial wound.Conclusion Good exposure and complete surgical removal of tumors can be achieved via transmaxillary approach for invasive tumors of the skull base.The postoperative defects of skull base can be repaired and reconstructed by different methods with good effect.