扩大鼻侧切开联合额骨开窗治疗颅鼻沟通瘤.doc

扩大鼻侧切开联合额骨开窗治疗颅鼻沟通瘤 目录 TOC \o "1-9" \h \z \u 目录 1 正文 1 文1：扩大鼻侧切开联合额骨开窗治疗颅鼻沟通瘤 1 1 资料与方法 2 2 结果 4 3 讨论 4 文2：小切口椎板间开窗治疗腰椎间盘突出症 6 1临床资料 6 参考文摘引言： 10 原创性声明（模板） 11 文章致谢（模板） 11 正文 扩大鼻侧切开联合额骨开窗治疗颅鼻沟通瘤 文1：扩大鼻侧切开联合额骨开窗治疗颅鼻沟通瘤 Extended Lateral Rhinotomy Combined with Fenestration in Frontal Bone for Resection of Communicational Neoplasms in Paranasal Sinus Abstract： Objective To explore the operative approach to cranionasal communicational tumo and the recotruction of cranial base We retrospectively reviewed the medical data including operative approach, repair material, postoperative complication, surgical outcome and survival rate in five patients with advanced malignant tumo in nasal cavities and paranasal sinuses involving frontal cranial fossa. Results All the patients were followed up for 3-5 yea. There was no death during operation and severe complicatio such as cerebrospinal fluid leakage, infection, and so on in this series. The 3year survival rate was 100% and the 5year survival rate was 80%. Conclusion Extended lateral rhinotomy, combined with fenestration in frontal bone for resection of communicational neoplasms in paranasal sinus, repairing of cranial base defect and recotruction of function at the same time, is a simple, safe and effective way and is worth applying in clinic. Key words： cranionasal communicational neoplasm; lateral rhinotomy; fenestration in frontal bone; cranial base recotruction 晚期鼻腔鼻窦肿瘤通过颅底骨间隙，或破坏颅底骨质进入颅内，形成颅鼻沟通瘤，由于该类肿瘤位置深在，解剖关系复杂， 治疗 非常棘手，肿瘤全切率低，术后造成严重畸形和功能障碍。随着影像技术飞速 发展 、手术器械的更新，麻醉方法、显微外科、成形外科的发展，对该类肿瘤的治疗有了长足的进步。2000—2002年，我们治疗颅鼻沟通瘤5例，获得了较好的临床效果，现报告如下。 1 资料与方法 一般资料 鼻腔、鼻窦肿瘤侵及前颅底的患者5例，男4例，女1例；年龄29～62岁，平均岁。病程2～10月，平均月。 临床表现 5例均有鼻塞，流脓血涕，鼻腔肿物，眼球突出，复视，偏头痛，患侧面部麻木，感觉减退或疼痛。其他表现还有头痛、呕吐、视神经乳头水肿等。病变位于鼻腔、上颌窦、筛窦，侵及前颅底。 影像学检查 5例均行CT或磁共振(MRI)检查，可清晰显示肿瘤范围及与周围组织结构的关系，均经筛板侵及前颅底，2例突破硬脑膜侵入脑实质。 病理类型 嗅神经母细胞瘤、横纹肌肉瘤、鳞癌、腺样囊性癌、内翻性乳头状瘤恶变各1例。详见表1。 表1 5名颅鼻沟通瘤患者临床资料详情表（略） 手术方法 麻醉与体位 （1）麻醉：采取气管插管静脉复合全身麻醉进行颅鼻联合手术治疗。（2）体位：病人仰卧于手术台上，头部抬高