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目的:总结颅底与近颅底区肿瘤的手术治疗效果。方法:前颅底区肿瘤58倒(良性8例,恶性50例)采用鼻骨移位进路前颅底大块切除和附加前额开窗,颅面联合切除;侧颅底区肿瘤27例(良性12例,恶性15例),良性肿瘤采用乳突切除和颈侧切开进路切除,恶性肿瘤分别采用颞骨次全切除-高位颈侧切开进路、颅中窝进路和颞下窝-颈侧切开-下颌骨外旋联合进路等三种进路切除;鼻咽部3例巨大良性肿瘤,采用鼻腔上颌窦与软腭切开进路切除。结果:23 例良性肿瘤经1-3年随访,除1例术后复发行再次手术切除外,其余均无复发。65例恶性肿瘤经5年以上随访,前颅底区恶性肿瘤三年生存率为64%,五年生存率为46.8%;侧颅底区恶性肿瘤三年生存率为46.7%,五年生存率为26.6%, 远期疗效较低与本组多为晚期病例有关。结论:本组病例根据肿瘤发生的部位、侵犯范围和病理类型所采用的手术方式, 能充分暴露病变,有利于肿瘤的切除,从而取得了较好的治疗效果,未发生严重并发症。
Objective: To summarize the surgical treatment of tumors in skull base and near skull base area. Methods: Anterior skull base tumor 58 down (benign in 8 cases, malignant in 50 cases) using nasal bone translocation anterior skull base resection and additional prefrontal fenestration, craniofacial resection; 27 cases of lateral skull base tumor (benign 12 cases of malignant, 15 cases of malignant), benign tumors were removed by mastotomy and neck incision approach, malignant tumors were subtotal temporal bone resection - high neck incision approach, midcranial fossa approach and infratemporal fossa - neck side Incision - external mandibular syndesmosis and other three routes of resection; nasopharyngeal 3 cases of large benign tumors, the nasal cavity using the maxillary sinus and soft palate incision approach resection. Results: Twenty-three patients with benign tumors were followed up for 1-3 years. No recurrence was found except for one case who underwent resection after operation. 65 cases of malignant tumors were followed up for more than 5 years. The three-year survival rate of anterior skull base area malignant tumor was 64% and the five-year survival rate was 46.8%. The three-year survival rate of skull base malignant tumor was 46.7%, and the five-year survival rate 26.6%, the long-term efficacy of this group are mostly late cases. Conclusion: This group of patients according to the tumor location, extent of invasion and pathological type of surgical approach used to fully expose the lesion is conducive to the removal of the tumor, which achieved good results, no serious complications.