颅颌面切除术治疗累及颅底的口腔颌面- 头颈部肿瘤-单中心10年回顾性研究

目的：回顾性分析近10年颅颌面联合切除手术资料的基础上，探讨对该类手术适应证的选择。方法：2003年2 月至2013年12月，上海交通大学医学院附属第九人民医院共行颅颌面联合切除术治疗累及颅底的肿瘤116 例，根据CT及MRI 冠状位所示的颅底受肿瘤侵犯情况分为3 类，Ⅰ型为肿瘤紧邻颅底但尚未破坏颅底骨质（n= 45）、Ⅱ型为肿瘤破坏颅底骨质但硬脑膜完整（n= 30）、Ⅲ型为肿瘤侵犯硬脑膜但未侵犯脑实质（n= 41）。 116 例患者的肿瘤均行颅颌面联合切除手术，并根据缺损情况分别采用邻近局部或区域组织瓣（n= 62）和游离血管化组织瓣（n= 54）修复缺损。结果：所有患者均顺利完成颅颌面联合切除手术，未发生术中并发症。组织瓣转移成功率为 98.3%，游离组织瓣转移成功率为96.4%。3 例分别因术后颅内感染（n= 2）和颈内动脉出血（n= 1）死亡。围手术期的并发症率为14.7% ，死亡率为2.6% 。94例患者随访6 月～11年，36例发现肿瘤复发或远处转移，总复发及转移率为38.5% 。肿瘤复发转移所致的死亡率为17.7% ，恶性肿瘤复发转移的死亡率为23.2% 。结论：对于颅颌面联合切除术应严格把握其适应证，注意肿瘤根治和术后功能、生存率和生存质量之间的平衡，即注重功能和外形、生存率和生存质量、供区和受区、重要功能和次要功能之间的平衡。

Cranio-maxillofacial resection for the treatment of oral,maxillofacial, head and neck tumors involving the skull base: a 10-year retrospective study at a single center

Objective:To review our patients who underwent cranio-maxillofacial resection in the recent10years and explore the indication of the operation. Methods:From2003to 2013, 116 patients underwent cranio-maxillofacial resection in our department for the treatment of tumors involving the skull base. Tumors that involved the skull base were divided into 3 types according to skull base invasions shown in the coronal planes of CT and MRI scans. Type 1 tumor was adjacent to the skull base with free bone ( n=45), type 2 tumor involved the skull base with intact dura ( n=30), and type 3 tumor involved dura with free brain ( n=41). All patients underwent cranio- maxillofacial resection by oral and maxillofacial surgeons and neurosurgeons. The defects after cranio- maxillofacial resection were reconstructed immediately with adjacent local or regional flaps (n=62) and free vascularized flap ( n=54) according to different de -fects, respectively. Results: Cranio- maxillofacial resection was successfully performed in all patients. No intraoperative complication was found. The overall success rate of soft tissue flaps and free flaps was98.3% and96.4%, respectively. Three patients with intracrani-al infection (n=2) and bleeding in the internal carotid artery were dead postoperatively even though they underwent salvage surgery. The overall rate of complications was14.7%, and the dead rate was 2.6%. Recurrence or distant metastasis was found in 36patients dur -ing the follow- up period. Conclusion:For the indication of cranio- maxillofacial resection, the balance between tumor resection and postoperative function, survival rate, and quality of life should always be considered. This technique includes the balance between func-tion and form, survival and quality of life, donor and recipient sites, and primary and secondary functions.