鼻内镜下手术治疗前颅底及蝶鞍区肿瘤(精选).docVIP

鼻内镜下手术治疗前颅底及蝶鞍区肿瘤 　　作者：陈成芳,李学忠,徐豪杰 作者单位：1. 山东大学齐鲁医院耳鼻咽喉-头颈外科, 济南 2. 山东中医药大学第二附属医院耳鼻咽喉-头颈外科， 济南 　　【摘要】 目的 探讨鼻内镜外科技术在前颅底及蝶鞍区肿瘤治疗中的方法及作用。 方法 2004年11月至2008年6月对16例侵犯前颅底与蝶鞍区的肿瘤行鼻内镜手术，其中1例采用眶内容物剜除术加鼻内镜联合入路，所有手术均于全麻下进行，病理类型包括垂体腺瘤6例，内翻性乳头状瘤5例，中分化鳞癌1例，脊索瘤1例，原始神经外胚层瘤1例，嗅母细胞瘤1例，骨化纤维瘤1例。术后随访3个月～4年。结果 经术中镜下、术后内镜或者影像学检查证实 15例肿瘤均被全部切除,1例脊索瘤为大部切除，1例垂体腺瘤患者术后出现脑脊液鼻漏, 经二次手术修补及规范治疗后痊愈。无颅内出血、感染及死亡病例。结论 内镜经鼻入路能够充分显露和切除前颅底及蝶鞍区肿瘤, 可以更好地辨认深部结构, 视觉效果好，是一种较好的手术入路。但要求术者熟练掌握解剖学知识，具备娴熟的手术技巧,先进的仪器设备以及必要的综合处理的经验。 　　【关键词】 内窥镜外科手术，颅窝, 前、中，蝶窦，蝶鞍，肿瘤 　　CHEN Chengfang1, LI Xuezhong1, XU Haojie2, CAI Xiaolan1, 　　ZHANG Liqiang1, LI Yanzhong1, LIU Zhonglu1 　　(1. Department of Otorhinolaryngology Head and Neck Surgery, Qilu Hospital of Shangdong University, 　　Jinan 250012, China; 2. Department of Otorhinolaryngology Head and Neck Surgery, 　　Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250012, China) 　　To explore the effect of a transnasal endoscopic approach for anterior skull base and sella region tumors. Methods Clinical data of 16 patients with anterior skull base tumors from November 2004 to June 2008 were retrospectively analyzed. All of them received transnasal endoscopic surgeries and one of them underwent evisceration of the orbit. All the operations were performed under general anesthesia. There were 6 pituitary adenomas, 5 inverted papilloma，1 squamous cell carcinoma， 1 chordoma, 1 primitive neuroectodemal tumor, 1 olfactory neuroblastoma, and 1 ossifying fibroma. The followup period ranged from 3 months to 4 years. Results Tumors were totally removed in 15 cases and subtotally removed in 1 case. Cerebrospinal leakage appeared after the operations and was cured by two operations in 1 case. There was no intracranial hemorrhage, intracranial infection or death in any patient. Conclusion An endonasal endoscopic approach can expose and completely remove anterior skull base and sella region tumors in appropriate ca