侵犯翼腭窝、颞下窝肿物的内镜手术入路选择

目的 探讨在侵犯翼腭窝、颞下窝肿瘤中选择内镜手术入路,为根据肿瘤性质和侵犯程度选择手术入路提供依据。方法 回顾分析第四军医大学西京医院2010年1月—2014年8月收治的50例侵犯翼腭窝或颞下窝并行内镜切除手术的肿瘤患者的临床资料,所有患者术前均行CT和MRI检查,根据肿瘤侵犯的方式和性质制定手术方案,选择手术入路。术后常规随访及影像学检查。重点评估不同入路的显露范围,安全手术的可能性,肿物全切率,以及术中、术后并发症。结果 经内镜手术治疗侵犯翼腭窝、颞下窝肿瘤50例,其中恶性肿瘤11例,包括腺样囊性癌5例,恶性成釉细胞瘤2例,软骨肉瘤2例,神经纤维肉瘤1例,恶性神经鞘膜瘤1例;良性肿瘤31例,鼻咽纤维血管瘤24例,神经鞘瘤5例,脊索瘤2例;囊肿8例,其中牙源性囊肿5例,表皮样或皮样囊肿3例。根据肿物侵犯范围,采用3种内镜下手术入路。内镜下经鼻腔入路27例,其中经中鼻道20例,经泪前隐窝7例;内镜下经柯-陆上颌窦入路9例;内镜下经鼻联合经柯-陆上颌窦入路14例。所有手术均能彻底切除肿物。随访时间6~55个月,平均34.3个月,3例失访,3例恶性肿瘤出现复发和远处转移。良性肿瘤和囊肿均无复发。结论 翼腭窝、颞下窝肿瘤在临床上并不少见,根据肿物的生物学特点、侵犯方式和范围选择恰当的手术入路,可以切除病变,降低并发症,减少手术创伤。

Selection of endoscopic approach to tumors located in pterygopalatine fossa and infratemporal fossa

PURPOSE: To describe different endoscopic approaches to remove tumors located in the pterygopalatine fossa (PPF) and infratemporal fossa (ITF) and to analyze the indications and outcomes of these surgical techniques in management of tumors localized in these areas. METHODS: Fifty patients with benign and malignant tumors arising in or extending to the PPF and ITF, treated from 2010 to 2014 at Xijing Hospital, Fourth Military Medical University were retrospectively reviewed. Before surgery, the patients underwent CT and MRI examination. According to tumor type and extent of invasion, three kinds of surgical plan and endoscopic approach were designed. The patients were followed up after surgery and the outcomes were assessed. RESULTS: Fifty consecutive patients were included, among them 31 had benign tumors (24 juvenile nasopharyngeal angiofibromas, 5 extracranial trigeminal schwannomas, 2 chordomas), 8 cases of cyst (5 odontogenic cysts, 3 epidermoid or dermoid cysts); 11 had malignant tumors (5 adenoid-cystic carcinomas, 2 malignant ameloblastomas, 2 chondrosarcomas, 1 neurofibrosarcoma and 1 malignant schwannoma). Three kinds of endoscopic approach were applied, including endoscopic endonasal approach in 27 cases, transmaxillary approach in 9 cases and combined endonasal and transmaxillary approach in 14 cases. Postoperatively, 8 patients with malignant tumors received adjuvant treatment. The mean follow-up was 34.3 months (from 6 to 55 months). Three patients were lost to follow-up, two patients with malignant tumor had recurrence, one patient with neurofibrosarcoma had metastasis. All patients with benign tumor and cyst had no recurrence. CONCLUSIONS: Tumors of PPF and ITF are not infrequent. According to tumors type, biological behaviors, we can select different appropriate endoscopic approaches to resect the tumors and reduce injuries and the incidences of complications at the same time.