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目的:探讨侵犯颅底的头颈部肿瘤的手术治疗方法。方法:对32例侵犯前、侧颅底的头颈部肿瘤患者进行手术治疗,采用鼻内镜下鼻腔入路5例,颅-面联合入路3例,上颌骨切除入路15例,口腔硬腭入路1例,经下颌入路1例,颈侧-下颌骨切开入路2例,耳后-颈联合入路1例,额颞入路2例,经面入路2例。结果:4例鼻窦黏液囊肿仅作开放引流,1例脊索瘤作次全切除,其余27例患者均全切肿瘤,无手术死亡及严重颅脑并发症。8例良性肿瘤患者随访6个月~8年情况良好,无肿瘤复发及死亡。24例恶性肿瘤患者,术后随访3年以上19例,生存12例;随访5年以上12例,生存5例;术后3、5年生存率分别为63.2%(12/19)和41.7%(5/12)。结论:根据病变性质、部位及范围设计手术入路,力求全切肿瘤并保护重要结构,采用适当的颅底修复方法,可获得良好的治疗效果。
Objective: To investigate the surgical treatment of head and neck tumors that infringe skull base. Methods: Thirty-two patients with head and neck tumor who had anterior and lateral cranial basement were treated by nasal endoscopic nasal approach in 5 cases, cranio-facial combined approach in 3 cases, maxillary resection approach in 15 cases, oral cavity 1 case under the palatal approach, 1 case under the mandibular approach, 2 cases under the neck-mandibular incision, 1 case under the posterior-neck joint approach, 2 cases under the frontotemporal approach and 2 cases via the transon approach. Results: Four cases of sinus mucinous cyst were only for open drainage and one case of chordoma for subtotal resection. The remaining 27 cases were completely resected and had no surgical death and severe brain complications. 8 patients with benign tumors were followed up for 6 months to 8 years in good condition, no tumor recurrence and death. Twenty-four patients with malignant tumor were followed up for more than 3 years and 19 cases were alive, 12 cases were followed up for more than 5 years and 5 cases were alive. The 3- and 5-year survival rates were 63.2% (12/19) and 41.7% (5/12). Conclusion: According to the nature, location and scope of the design of surgical approach, and strive to cut the entire tumor and protect the important structure, the appropriate skull base repair method, can obtain good therapeutic effect.