摘要
目的探讨采用上颌骨翻转面部移位入路手术切除侵及颅底肿瘤的并发症及临床意义。方法40例颅底肿瘤患者,均采用上颌骨翻转面部移位入路手术切除。结果40例患者均达到显微镜下肿瘤全切除或次全切除。全部患者获1～70个月随访,平均30.7个月。1例术后第30天行面部创腔冲洗吸引时突发颈内动脉大出血休克死亡,因肿瘤复发死亡7例,与肿瘤无关死亡2例。带瘤生存5例,其余25例均无肿瘤复发。手术并发症包括:转移组织瓣部分坏死2例,腭小瘘3例,脑脊液漏3例,创腔感染2例,患侧听力下降、耳鸣5例,手术侧眼球运动障碍3例,张口受限5例,1例术后出现咽喉部肿胀致阻塞性通气困难,行气管切开呼吸机辅助呼吸,7d后好转,脱机拔管。无1例出现上颌骨坏死。结论上颌骨翻转面部移位入路手术切除颅底肿瘤具有显露充分、肿瘤切除彻底的优点,疗效满意,发生严重影响患者生活质量的并发症的可能性不大,可作为较广泛浸润颅底肿瘤手术的一种治疗选择。
Objective To study the complication and clinical significance of surgery through transmaxillary approach for the tumors invading skull bases. Method Forty patients with tumors invading skull bases were treated by surgery through transmaxillary approach. Results The total or subtotal removal of tumors were achieved under an operating microscope in all the patients. All the patients were followed up from 1 to 70 months （mean, 30.7 months）. One patient died of rupture of internal carotid artery during rinsing craniofacial wound and sucking the rinsing fluid 30 days after the operation. Recurrence of the tumors was observed in 12 patient （5 patient has good living quality and 7 patients died）. Two patients died of the other diseases. There were not recurrence of the tumors in 25 patients. The postoperative complications included the partial necrosis of translocation tissues in 2 patients, palatal leakage in 3, CSF leakage in 3, wound infection in 2, tinnitus and decrease in the heating ability of the operative side in 5, eyeball movement disorder of operative side in 3, difficultly opening mouth in 5, and obstructive dyspnea duo to swelling of laryngopharynx 1 day after the operation in 1, in whom tracbeotomy and respiratiory device-assisted respiration were performed and the tube was withdrew 7 days later. The necrosis of maxillary bones did not occurred in all the patients. Conclusion Better exposure and complete removal of tumors can be achieved by surgery through transmaxillary approach, which has good curative effects and less complications in the patients with tumors invading skull base.
出处
《中国临床神经外科杂志》
2007年第7期391-393,共3页
Chinese Journal of Clinical Neurosurgery
关键词
肿瘤
颅底
神经外科手术治疗
并发症
Tumors
Skull base
Neurosurgical technique
Complications
