内镜下经鼻人路治疗颅底中央区恶性肿瘤

目的探讨内镜下经鼻人路切除颅底中央区恶性肿瘤的手术方法和治疗效果。方法回顾性分析颅底恶性肿瘤32例。采用内镜下经鼻人路27例，颅一鼻联合人路5例；其中术后行一期颅底重建16例。结果肿瘤全切除15例，近全切除13例。部分切除4例。术后症状明显改善或缓解23例，无明显好转9例。主要并发症为：脑脊液鼻漏和颅内感染各1例，均治愈；无颅内出血及死亡病例。随访6，74个月，平均27．8个月；至随访期结束，无肿瘤复发10例，带瘤生存12例，死亡10例，5年生存率46．2％。病人术后3个月KPS评分比人院时显著提高（P〈0．05）。结论内镜下经鼻入路结合可靠的颅底重建，能有效切除颅底中央区恶性肿瘤，并提高病人近期生活质量。

Endoscopic endonasal surgery for malignancies in central areas of the skull base

Objective To summarize the surgical method and therapeutic result of endoscopic endonasal approach for malignancies in central areas of skull base. Methods Clinical data of 32 patients with malignancies of skull base were analyzed retrospectively, including endoscope endonasal approach in 27 cases and endoscopic endonasal approach combined with subfrontal approach in 5. Skull base reconstruction was performed in 16 patients after tumor resection. Results Total tumor resection was achieved in 15 patients, subtotal resection in 13 and partial resection in 4. The symptoms were significantly ameliorated in 23 patients and not obviously improved in 9 after the operation. Cerebrospinal fluid rhinorrhea and intracranial infection were the major complications after surgery, which happened in 1 patient each, and cured by conservative treatment. There was no death or intracranial hemorrhage case. During a mean follow-up period of 27.8 months （ranging from 6 to 74 months）, 10 patients were tumor-free survival, 12 survival with tumors and 10 died. Five-year overall survival rate was 46.2%. KPS scores 3 months after operation significantly increased compared with preoperation. Conclusion Endoscopic endonasal approach with good skull base reconstruction can effectively reseet the malignancies in the central area of the skull base and improve the life-of-quality in a short-term period.