前颅底沟通肿瘤的外科治疗

发布时间：2018-03-11 19:30

本文选题：前颅底　切入点：沟通肿瘤　出处：《北京协和医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的前颅底沟通肿瘤因其位置及解剖结构的特殊性,常常侵犯毗邻结构,如颅底、鼻窦、眼眶及其周围的血管神经,手术风险高、难度大,导致此类肿瘤的全切除率低、复发率高;而且肿瘤切除后颅腔、鼻腔沟通,术后易出现脑脊液漏、颅内感染等严重并发症,因此前颅底沟通瘤的外科治疗成为外科医生不断探索的方向。回顾性分析我院2009年5月到2016年8月收治的38例前颅底沟通肿瘤患者病例资料,探讨前颅底沟通肿瘤理想的诊疗方案与手术方法。方法男性患者19例,女性患者19例。术前所有患者均行MRI、CT检查,明确肿瘤的性质及侵及范围,并经多学科讨论,明确患者术前是否需要诱导治疗、手术方式及术后辅助治疗。38例患者我们均采用经改良Derome入路切除肿瘤,术后结合肿瘤切除情况与病理结果,由肿瘤内科、放射治疗科完善综合治疗。结果良性肿瘤15例,恶性肿瘤23例;肿瘤全切除32例(84.2%),次全切除6例(15.8%),并发症发生率为31.6%(12/38),无手术死亡病例。38例患者中,2例失访,其余36例随访时间为2-89月,恶性肿瘤的5年生存率为66.2%。结论前颅底区肿瘤病理类型复杂,其中又以恶性居多(本组中占60.5%),以手术为主的多学科综合治疗可明显延长患者生存率、提高生活质量;通过经改良Derome入路一期切除前颅底沟通肿瘤,可避免面部疤痕、增加根治性切除肿瘤的几率;采用颞肌筋膜及带血管蒂额肌骨膜瓣双层修复颅底,能明显降低脑脊液漏及颅内感染等并发症的发生率。术后规范化综合治疗能提高局部控制率和总体生存率。
[Abstract]:Objective because of its special location and anatomical structure, anterior skull base communication tumor often invades adjacent structures, such as cranial base, paranasal sinus, orbit and its surrounding vessels and nerves. The risk of operation is high and the difficulty is great, which leads to the low rate of total resection of this kind of tumor. The recurrence rate is high, and after resection of the tumor, the cranial cavity and nasal cavity communicate with each other. After the operation, serious complications such as cerebrospinal fluid leakage, intracranial infection, and so on are easy to occur. Therefore, surgical treatment of anterior skull base communication tumor has become the direction of exploration by surgeons. The data of 38 patients with anterior skull base communication tumor admitted in our hospital from May 2009 to August 2016 were retrospectively analyzed. Methods 19 cases of male patients and 19 cases of female patients were examined by MRICT before operation to determine the nature and extent of tumor invasion. To determine whether the patients need induction treatment before operation, surgical methods and postoperative adjuvant treatment. We all used modified Derome approach to remove the tumor. After operation, combined with the tumor resection and pathological results, the internal department of oncology, Results there were 15 cases of benign tumor, 23 cases of malignant tumor, 32 cases of total resection of tumor 84.22 and 6 cases of subtotal resection. The incidence of complications was 31.612% 38%. The other 36 cases were followed up for 2-89 months, and the 5-year survival rate of malignant tumors was 66.2. Conclusion the pathological types of tumors in the anterior skull base region are complicated, and the malignant tumors are the most (60.5% in this group). To improve the quality of life; to avoid facial scars and increase the probability of radical resection of tumors by one-stage resection of the anterior skull base through a modified Derome approach; to repair the skull base with a double layer of temporalis fascia and vascularized frontalis periosteum flap. The rate of complications such as cerebrospinal fluid leakage and intracranial infection can be significantly reduced, and the local control rate and overall survival rate can be improved by standardized comprehensive treatment.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.41

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