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目的 探讨颅底区手术后骨及软组织缺损的 期修复重建方法。方法 对 38例颅底恶性肿瘤患者 ,手术切除所致颅底软硬组织缺损进行了 期修复。修复材料主要为带蒂斜方肌下部岛状肌皮瓣 8例 ,带蒂胸大肌下部岛状肌皮瓣 5例 ,带蒂颞肌复合组织瓣或带蒂颞肌筋膜帽状腱膜瓣 +骨块 +游离皮片共 17例 ,额肌复合组织瓣 7例 ,前臂皮瓣血管吻合游离移植 1例。组织瓣面积 8cm× 10 cm～ 7cm× 2 5 cm。结果 组织瓣成活率 89.47% (34/ 38例 ) ,术后并发症率18.4% (7/ 38例 ) ,其中肌皮瓣部分坏死 10 .5 % (4 / 38) ,脑脊液漏 5 .2 % (2 / 38) ,颅内感染 2 .6 % (1/ 38例 ) ,均经对症治疗后痊愈。结论 颅底组织缺损采用显微外科技术 期修复重建能够有效地预防严重的手术后并发症 ,尤以带血管蒂组织瓣转位移植术修复重建颅底区组织缺损的方法具有组织瓣存活率高 ,易掌握和可靠性强等优点 ,可做颅底区修复重建的首选方法。
Objective To investigate the repair and reconstruction of bone and soft tissue defects after skull base surgery. Methods Thirty-eight patients with skull base tumor were repaired by surgical excision of soft tissue and soft tissue defect. The main repair materials were pedicled trapezius myocutaneous island flap in 8 cases, pedunculated pectoralis major island myocutaneous flap in 5 cases, pedunculated temporalis muscle flap or pedicled temporal fascia cap aponeurosis Flap + free skull flap 17 cases, frontal muscle compound flap in 7 cases, forearm flap vascular graft in 1 case. Tissue flap area 8cm × 10cm ~ 7cm × 25cm. Results The survival rate of tissue flap was 89.47% (34/38 cases) and the postoperative complication rate was 18.4% (7/38 cases), with partial necrosis of myocutaneous flap of 10.5% (4/38) and cerebrospinal fluid leakage of 5.2% (2/38), intracranial infection 2.6% (1/38 cases), were cured after symptomatic treatment. Conclusion Microsurgery repair and reconstruction of skull base defect can effectively prevent serious postoperative complications. Especially, the method of transplanting pedicle flap pedicled with vascularized pedicle flap for reconstructing the tissue defect in skull base area has the advantages of high tissue flap survival rate , Easy to grasp and reliability, etc., can be the preferred method of repair and reconstruction of skull base area.