前、中、侧颅底恶性肿瘤手术径路的探讨

目的：评价前、中、侧颅底手术径路的实用性，可靠性及有效性。方法：自1984年6月至1998年12月，对30例颅底恶性肿瘤患者进行治疗。病变位于前颅底者13例，中颅底2例和侧颅底15例（包括4例中、外耳道癌患者）。累及前颅底者采用发际内大冠状切口并切除部分额骨入颅。或经额窦后壁入颅，然后实行颅面联合切除肿瘤，涉及中、侧颅底肿瘤则采用经颈－下颌入路方法整块切除肿瘤。中、外耳癌则实行颞骨次全切除术。结果：全组30例无手术死亡。无严重并发症，合并脑脊液漏等轻度并发症者6例（20％），均经保守治愈。全组2年生存率为68％，5年生存率55．56％。结论：上述资料显示所提出的颅底恶性肿瘤手术径路方法安全可靠，适合于大多数前、中、侧颅底恶性肿瘤的治疗，值得推广应用。

Anterior, medial and lateral approach for skull base surgery

Objective To evaluate the effect of anterior, medial and lateral approach for skull base cancer. Methods From June 1984 to December 1998, 30 patients (male 21, femal 9; age: 25-66 years) with anterior, medial, and lateral skull base cancer were treated by surgery. The anterior skull base cancer was resected by craniofacial combined approach through resecting frontal bone and posterior wall of the frontal sinus. The medial-lateral skull base cancer was resected through transcervical transmandibular approach. The ear cancer was treated by subtotal temporal bone resection. Results There were no postoperative death and no fatal complications. Four patients had minor cerebrospinal fluid leak, and 2 had partial flap lost. All 6 patients recovered by palliative management. in this series, the 2 year survival rate was 68%, and 5 year survival rate 55%. Conclusion These data show that the anterior, medial and lateral approaches for treating patients of skull base cancer are effective and reliable in most clinical situations.