累及前颅底的鼻腔鼻窦恶性肿瘤术式选择及颅底重建方法的探讨

目的：探讨鼻腔鼻窦恶性肿瘤累及前颅底的术式选择及术后颅底缺损重建技术。方法：对22例本病患者根据颅底骨质缺损的大小和肿瘤突入颅内的高度，分别采用鼻侧切开术、扩大的鼻侧切开术或颅面联合手术，采用多层筋膜瓣修补颅底缺损。结果：瘤体全切率为100％，术后无脑脊液漏、脑膜脑膨出等并发症发生。随访6个月至11年，存活1年以上者19例，3年以上者15例，5年以上者13例；死亡7例。有眶骨膜受累的9例患者，存活3年以上4例，5年以上2例。结论：术式选择取决于前颅底骨质缺损的大小、肿瘤侵入颅内的程度以及肿瘤范围；多层筋膜瓣可用于较大颅底缺损的术中重建，具有安全、取材方便、效果好等优点，值得推广。

Selection of operative approaches for rhinosinusal malignant tumor involving in the anterior skull base and exploration for reconstruction

Objective:To investigate operative approaches and techniques of reconstruction for rhinosinusal malignant tumors involving in the anterior skull base.Method:In a retrospective study, clinical data of 22 patients treated surgically in our department from 1988 to 2002 were analysed. Lateral rhinotomy was carried out in 8 patients and ampliative rhinotomy in 4 patients; in 10 patients craniofacial operation was performed. Multiple layer fascia flaps were used to repair lager defect in the anterior skull base.Result:All tumors were totally resected. In lateral rhinotomy, local locoeled meningitis happened in 1 case, and 4 patients in craniofacial operation. None complication with cerebrospinal fluid leaks, encephalomeningocele and intracranial air. All patients were followed up from 6 months to 11 years after surgery. 7 patients died from intracranial infection or metastasis of tumor.3-year survival rates was 15/19( 78.9%); 5-year survival rates was 13/19( 68.4%). The tumor invaded the orbital fascia in 9 patients. Vs 4/9 ( 44.4%) and 2/9( 22.2%) for these 3 and 5-year survival rates.Conclusion:Selection of operative approaches depends on the size of defects in the anterior skull base , extent of intracranial invasion and location of rhinosinusal malignant tumors; multiple layer fascia flaps can be used to reconstruct bigger defects of the skull base. It is safe, technically easy, effective procedure and worthy to be recommended.