面部移位入路手术切除自鼻咽向上侵及颅底的肿瘤

目的探讨采用上颌骨翻转面部移位入路手术切除自鼻咽向上侵及颅底肿瘤的疗效及临床意义。方法对40例自鼻咽向上侵及颅底的肿瘤均采用上颌骨翻转面部移位入路手术切除,其中38例同时修补颅底。结果本组均达到显微镜下肿瘤全切除或次全切除。全部病人获35～85个月随访,平均49.7个月;因肿瘤复发死亡9例,带瘤生存8例,其余23例无肿瘤复发。手术并发症包括创腔感染2例,病侧听力下降、耳鸣5例,手术侧眼球运动障碍3例,张口受限5例。结论上颌骨翻转面部移位入路手术切除自鼻咽向上侵及颅底的肿瘤具有显露充分、肿瘤切除彻底的优点,可取得满意的疗效。

Transmaxillary approach for invasive tumors of skull base from nasopharynx

Objective To study the effectiveness and clinical significance of transmaxillary approach for invasive tumors of skull base from nasopharynx. Methods Forty patients with invasive tumors of skull base from nasopharynx were operated for tumor resection via transmaxillary approach, with skull base repair in 40 cases. Results Total or subtotal removal of tumor was achieved in all the patients. All the patients were followed up from 35 to 85 months with mean duration of 49.7 months. Recurrence was observed in 17 patients with good quality-of-life in 8 cases, and death in other 9. There was no recurrence in the other 23 patients. The postoperative complications included infection in 2 cases, tinnitus and decreased hearing ability of the operative side in 5, eyeball movement disorder of the operative side in 3, and difficulty with mouth opening in 5. Conclusion Better exposure and complete removal of tumors could be achieved by transmaxillary approach for surgical removal of invasive tumors of skull base from nasopharynx with satisfactory therapeutic result.