肿瘤致颅顶部穿通性组织缺损的修复

目的:探讨肿瘤致颅顶部穿通性组织缺损的外科修复方法和临床效果。方法:回顾性分析我院30例颅顶部肿瘤切除后造成的穿通性组织缺损修复方法。头皮软组织层修复:局部头皮瓣或/和供区游离皮片移植术修复23例;带血管蒂肌皮瓣5例;吻合血管的前臂游离皮瓣2例。颅骨修复:一期钛板修复10例,二期钛板修复2例,其余18例未修复。硬脑膜修复:30例均行硬脑膜修补,除3例用人工脑膜补片外,其余全部用自体材料包括颅骨骨膜、颞肌筋膜、帽状腱膜、阔筋膜。术后16例行放射治疗,剂量50Gy~75Gy,4例行化学治疗。结果:主要并发症有皮瓣部分坏死4例、脑脊液漏2例、颅内感染1例、癫痫2例、轻偏瘫2例、下极面瘫1例、昏迷7天后苏醒1例。结论:肿瘤致颅顶部穿通性组织缺损可以成功修复,关闭颅腔,术后行综合治疗,患者生存率和生存质量得到改善。

The Repairment of the Defection Caused by Transcranial Tumor of the Scalp and Skull Area

Objective: To explore the method and to evaluate the effect of surgical repairment of the defection by transcranial tumor of the scalp and skull area.Methods: 30 patients with transcranial tumor of the scalp and skull area were reviewed for the excision and repairment style.The repairing methods included local scalp flap with free transferring skin(23 cases),and musculo-cutaneous flap with artery stalk(5 cases),free vascularized forearm flap(2 cases).The skull and cerebral dura mater defect were repaired by titanium,temporalis fascia,skull periosteum and so on.After operation 16 cases were treated by radiotherapy(50Gy~75Gy),4 cases were treated by chemotherapy.Results: The major complications included local flap necrosis(4 cases),cerebrospinal rhinorrhea(2 cases),infection in cranial cavity(1 cases),epilepsy(2 cases),hemiplegia(2 cases),peripheral facial paralysis(1 cases),coma for 7days(1 cases).Conclusion: The defection caused by transcranial tumor of the scalp and skull area could be repaired successfully.The patients' survival qauality was obviously improved by combining postoperative radiotherapy and chemotherapy.