颅底及近颅底肿瘤手术入路(附126例报告)

目的探讨颅底及近颅底肿瘤切除的最佳手术入路.方法颅底及近颅底肿瘤患者126例,手术采用上、下颌外旋入路分别为13、17例耳后C型切口、经颈、颅面联合入路分别为16、48、6例;上颌骨截除术5例;鼻侧切开术5例;经腮、口、颈额、额眶入路分别为5、6、4、1例.结果89例良性肿瘤,2例复发经再次手术治愈;37例恶性肿瘤中,术后存活不足1年者4例,1年、2年、3年、5年以上者分别为6、12、10、5例.结论上颌外旋适用于切除前、中颅底肿瘤;下颌外旋适用于切除咽旁间隙良性肿瘤;耳后C型切口入路适用于颞骨肿瘤;额眶入路适用于切除眶顶、蝶骨肿瘤.

APPROACHES TO SKULL BASE NEOPLASMS

Objective:To reseach for better approaches for the resection of anterior and lateral skull base tumors.Methods:126 patients with skull base tumors were treated by surgery,the surgical procedures were maxillary and mandibular swing approach in 13 and 17 cases respectively;opisthotic C incision,cervical and craniofical approach in 16\,48 and 6 cases respectively;maxmectomy in 5 cases,lateralrhinotomy in 5 cases;transparotid,transoral, temporofrontal and frontalorbit approach in 5\,6\,4 and 1 cases respectively.Results:In 89 cases of benign tumor,2 recurrence at one year postoperatively.ln 37 cases of malignant tumors,4 died in one year postoperatively,6 survived for one year,12 for two years,10 for three years,5 for five years.Conclusion:The maxillary swing approach provide maximum direct exposure of anterior and middle skull base tumors.The mandibular swing approach is suitable for removal of parapharyngeal space,infratemporal fossa,pharynx,sphenoid,clivus and upper cervical vertebrae tumors.The cervical approach suit to benign parapharyngeal tumors.The opisthotic C incision approach apply to resection of temporal tumors.The frontalorbit approach is a proper procedure for orbitsphenoid tumors.