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目的探讨涉及颅底的肿瘤切除的最佳手术入路。方法回顾性分析1992—2002年手术治疗涉及颅底的肿瘤79例。采用了11种手术入路,如面中掀翻、额冠状切开、鼻外翻、上颌骨外旋、上颌骨部分切除、眶内容剜除、下颌骨切开外旋、额+颞+耳前+颈、额+颞+耳后+颈、颞+耳后+颈、颞+口及相互组合的联合入路,彻底切除了累及颞下窝、翼腭窝、鼻窦、鼻咽部、颅底、桥脑小脑角、大脑额叶和颞叶的肿瘤。结果79例患者均彻底切除了肿瘤, 5例并发脑脊液漏,均在1周内自愈,无手术死亡及严重颅脑并发症。良性肿瘤29例,其中脑膜瘤11例,神经纤维瘤9例,软骨瘤3例,骨纤维异常增殖症2例,血管瘤型脑膜瘤、海绵状血管瘤、颈静脉球体瘤、神经鞘膜瘤各1例,随访至今情况良好, 19例患者存活超过5年,生存期最长1例已超过8年。恶性肿瘤50例,其中肉瘤、高分化鳞癌各3例,中分化鳞癌17例,低分化鳞癌11例,乳头状瘤恶变5例,软骨肉瘤、腺癌、恶性纤维组织细胞瘤、恶性混合瘤各2例,未分化癌、嗅神经母细胞瘤、纤维肉瘤各1例。所有病例均进行了随访,无失访患者。直接法统计3年、5年生存率分别为59 2% (29 /49)、38 5% (10 /26)。结论对每位患者应根据不同的病变性质和累及范围,按照最短路径,避开重要血管和神经,尽可能利用已存在的或潜在的“间隙”保
Objective To investigate the best surgical approach involving tumor resection of skull base. Methods Retrospective analysis of 1992-2002 surgical treatment of 79 cases of tumors involving the skull base. Using 11 kinds of surgical approach, such as face overturned, frontal coronal incision, nasal eversion, maxillary external rotation, maxillary partial resection, removal of orbital content, external mandibular incision, frontal + temporal + ear Front + neck, frontal + temporal + ear + neck, temporal + posterior + neck, temporal + mouth and combination of the combined approach to completely remove the involvement of the infratemporal fossa, pterygopalatine fossa, sinuses, nasopharynx, Bottom, cerebellopontine angle, frontal and temporal lobes of the brain. Results Totally 79 patients had complete tumor excision and 5 patients with cerebrospinal fluid leakage. All of them recovered within 1 week without any operative death and severe brain complications. Among the 29 benign tumors, 11 were meningiomas, 9 were neurofibromas, 3 were chondroma, 2 were fibrous dysplasias, 2 were hemangiomas, cavernous hemangiomas, jugular bulbomas, 1 case in each case, up to now the situation is good, 19 patients survived more than 5 years, the longest survival of 1 case more than 8 years. 50 cases of malignant tumors, including sarcoma, 3 cases of well-differentiated squamous cell carcinoma, 17 cases of moderately differentiated squamous cell carcinoma, 11 cases of poorly differentiated squamous cell carcinoma, 5 cases of malignant papillomatosis, chondrosarcoma, adenocarcinoma, malignant fibrous histiocytoma, malignant Mixed tumor in 2 cases, undifferentiated carcinoma, olfactory neuroblastoma, fibrosarcoma in 1 case. All cases were followed up, no lost patients. Direct statistics of 3 years, 5-year survival rates were 59 2% (29/49), 38 5% (10/26). Conclusion Each patient should be based on the nature and extent of the lesion according to the shortest path, avoiding important blood vessels and nerves, as far as possible the use of existing or potential “gap” Paul