鼻颅底肿瘤的内镜手术治疗

目的:分析鼻相关颅底肿瘤内镜手术的意义,探讨其适应证、入路及相关并发症的预防。方法:鼻相关颅底肿瘤48例,均在内镜下进行手术,根据肿瘤的发生部位、累及范围及性质分别采取经筛,鼻中隔经蝶,经扩大上颌窦后壁,鼻腔外侧壁,鼻外上颌骨,经口咽后壁等手术入路切除肿瘤。结果:肿瘤全切率81.3%(39/48),次全切除14.6%(7/48),大部分切除4.1%(2/48),并发症发生率18.7%(9/48),无致残及致死病例。随诊3个月至6年,中位随诊时间3年,良性肿瘤复发率8.3%(4/30),无死亡病例。恶性肿瘤Kaplan-Meier法计算3年生存率75%,5年生存率57.6%。结论:术前评估,掌握内镜手术的适应证及相关技术,采用合理的手术入路,采取恰当的方式切除肿瘤,与相关学科密切合作,保证手术的安全性,可预防并减少并发症。

Treatment of endoscopic surgery for nasal-skull base neoplasms

Objective： To analyze the endoscopic surgery of nasal-skull base neoplasms. The secondary objective was to discuss the indication, approach and prevention of complications. Methods： Fortyeight patients with nasal-skull base tumors undergoing endoscopic or endoscope-assisted surgery were included in this study. Surgical approaches included endoscopic endonasal transethmoidal approaches, endoscopic endonasal transseptal transsphenoidal approach, extended endoscopic transmaxillary posterial wall approach endoscopic nasal lateral wall dissection, maxillary osteotomy approach and endoscopic transoropharyngeal approach. These approaches were selectively used to resect the tumors in the area of nasal-skull base. Results .. The total resection of the tumors was obtained in 48 patients （81.3%,39/48）, the rate of deuto-resection was （14.6%, 7/48）, the rate of partly resection was （4.1%, 2/48）, with （18.7%, 9/48） incidence of complications, no catastrophic complications, sequelae and operative mortality encountered. Three months to 6 years follow up （median 0.3 years）, indicated that recurrence rate of the benign tumor was 8. 3% （4/30） without died case, and 3-year and 5-year survival rates of the malignant tumor were 75% and 57.6%, respectively. Conclution： Strategies proved to be effective in reduction of the overall incidence of the complications. The strategies were as follows： first, predicting surgical risks preoperatively and grasping reasonable indication. Second, designing appropriate endoscopic approaches for the treatment of skull base tumor; lastly, acquainted with the endoscopic skills and familiarized the skull base structures.