鼻前颅底的解剖学特点及鼻内镜下鼻前颅底恶性肿瘤治疗运用的相关分析(1)
摘要:目的:分析鼻前颅底的解剖学特点,探讨鼻内镜下鼻前颅底恶性肿瘤的治疗运用。方法:选取我院2008年9月~2010年9月收治的71例鼻前颅底恶性肿瘤患者,应用鼻内镜微创手术,观察其复发情况及无瘤生存率;并选取20例尸头标本,分为解剖组及鼻内镜组,每组各10例,分别在局部解剖及鼻内镜下观察其解剖学特点,并进行比较。结果: 71例患者均获得有效随访,平均随访时间(35.1±6.2)个月,至随访结束时,共有15例患者出现局部复发,复发率21.1%,无瘤生存34例,无瘤生存率47.9%,带瘤生存22例,带瘤生存率31.0%,病死15例,病死率21.1%。不同尸头中各项观察指标的最大、最小值均存在较大差异;鼻内镜下与局部解剖下观察视神经管形态及走行结果一致;结论:鼻前颅底区域的解剖关系较为复杂,有重要的神经及血管走行,使得传统鼻侧切开手术风险较大,鼻内镜下鼻前颅底恶性肿瘤切除术具有术野暴露好、光线充足、创伤小、切除范围广等优势,可有效保证患者的生存率,降低复发风险,是一种安全、有效的治疗方式,在外科治疗中可予以推广。
关键词:鼻前颅底;解剖;鼻内镜;恶性肿瘤;治疗
, 百拇医药
Correlation analysis of anterior skull base m alignant tumor treatment by nasal nasal skull base anatomy and endoscopic(不是相关性分析,而是研究鼻颅底结构特点以及分析鼻内镜技术在治疗这一区域恶性肿瘤中的应用)
Abstract: Objective: Analysis of anatomical characteristics of nose不是鼻部的结构特征, to explore the use of endoscopic treatment of nasal skull base m alignant tumor. Methods: 71 cases of nasal skull base m alignant tumor patients in our hospital in 2008 September ~2010 year September, endoscopic minimally invasive operation, observe the recurrence and disease-free survival rate; and to select 20 cases of cadaveric head specimens, divided into anatomical group and nasal endoscopic group, 10 cases in each group, respectively, to observe the anatomical characteristics in local anatomy and endoscopic, and compare. Results: The maximum, minimum value of different cadaveric heads in the observed indexes were different; endoscopic and local anatomy observation of the optic canal morphology and running results; 71 patients were followed up for an average follow-up time, (35.1 ± 6.2) months, to the end of follow-up, a total of 15 patients the emergence of local recurrence, the recurrence rate was 21.1%, tumor free survival of 34 cases, tumor free survival rate was 47.9%, survival with tumor in 22 cases, the survival rate was 31%, 15 cases died, the mortality was 21.1%.Conclusion: The anatomical relationship between the nose region is more complex, with nerve and vessel important running, the traditional nasal lateral incision operation risk, endoscopic anterior skull base tumor resection has good operating field exposure, adequate light, small trauma, resection range and other advantages, can effectively guarantee the survival rate of patients, to reduce the risk of recurrence, is a safe, effective treatment, can be popularized in surgical treatment.
, 百拇医药
Keywords: nose; anatomy; nasal endoscope; m alignant tumor; treatment
鼻前颅底恶性肿瘤的高发区域为鼻腔及鼻窦,该部位解剖结构与眼眶、大脑额叶等结构毗邻,患者可表现为顽固性头痛、视力下降和眼肌麻痹等症状[1]。目前鼻前颅底肿瘤的常用治疗方法为传统的鼻侧切开术,创伤较大,不利于患者的美观。20世纪70年代鼻内镜技术逐渐得到了广泛应用,但由于鼻前颅底解剖结构复杂,手术难度极大[2]。为详细分析鼻前颅底的解剖学特点,并分析鼻内镜在对该部位恶性肿瘤治疗中的应用,笔者进行了相关分析,现报道如下:
1材料与方法
1.1临床资料
选取我院2008年9月~2010年9月收治的71例鼻前颅底恶性肿瘤患者,均经CT、MRI及病理组织学检查确诊[3],排除:癌细胞已侵袭脑实质、额窦前外侧壁或眶内组织。其中男性59例,女性12例,年龄28~63岁,平均(49.2±8.4)岁,病理类型:嗅神经母细胞瘤21例,恶性黑色素瘤17例,鳞状细胞癌11例,脊索瘤10例,黏液表皮样癌8例,蝶筛窦腺癌4例;治疗史:9例患者曾接受手术治疗,13例患者曾接受手术+化疗,8例患者接受手术+放疗,其他患者均为首次确诊。并选取20例尸头标本,不分性别,排除:①发现鼻部或鼻窦畸形;②死亡前存在面部外伤或面部手术史。将上述20例标本分为解剖组及鼻内镜组,每组各10例,分别在局部解剖及鼻内镜下观察其解剖学特点。
, 百拇医药
1.2手术方法
按照患者病理类型选择合适的术式进行鼻内镜下切除:①嗅神经母细胞瘤:对Kadish分期为A、B期患者可仅实施鼻内镜下肿瘤切除及邻近组织清扫[4],对C期患者予以术前放疗,剂量50 Gy,待CT、MRI下显示肿瘤区域减小后实施肿瘤全切。术后全部嗅神经母细胞瘤患者均接受放疗,放疗剂量50~60 Gy,视其实际情况而定;②恶性黑色素瘤:若肿瘤未侵犯颅底骨质,可仅将肿瘤及安全缘切除,若肿瘤对颅底骨质造成侵犯,则使用磨钻自肿瘤侵犯位置将骨质钻开,并将筛骨纸样板切除,暴露肿瘤,实施切除。术后患者接受辅助放疗;③鳞状细胞癌、黏液表皮样癌、蝶筛窦腺癌:可实施鼻内镜下肿瘤组织安全缘范围内完整切除,并于术后实施辅助放疗;④脊索瘤:切除鼻中隔后部,分层切除肿瘤,并使用双极电凝处理肿瘤周边组织,若发现患者存在颅底骨质缺损,则在肿瘤全切后行黏膜瓣修补,术后亦实施辅助放疗。, 百拇医药(陆璐 卢永田 王晓彬)
关键词:鼻前颅底;解剖;鼻内镜;恶性肿瘤;治疗
, 百拇医药
Correlation analysis of anterior skull base m alignant tumor treatment by nasal nasal skull base anatomy and endoscopic(不是相关性分析,而是研究鼻颅底结构特点以及分析鼻内镜技术在治疗这一区域恶性肿瘤中的应用)
Abstract: Objective: Analysis of anatomical characteristics of nose不是鼻部的结构特征, to explore the use of endoscopic treatment of nasal skull base m alignant tumor. Methods: 71 cases of nasal skull base m alignant tumor patients in our hospital in 2008 September ~2010 year September, endoscopic minimally invasive operation, observe the recurrence and disease-free survival rate; and to select 20 cases of cadaveric head specimens, divided into anatomical group and nasal endoscopic group, 10 cases in each group, respectively, to observe the anatomical characteristics in local anatomy and endoscopic, and compare. Results: The maximum, minimum value of different cadaveric heads in the observed indexes were different; endoscopic and local anatomy observation of the optic canal morphology and running results; 71 patients were followed up for an average follow-up time, (35.1 ± 6.2) months, to the end of follow-up, a total of 15 patients the emergence of local recurrence, the recurrence rate was 21.1%, tumor free survival of 34 cases, tumor free survival rate was 47.9%, survival with tumor in 22 cases, the survival rate was 31%, 15 cases died, the mortality was 21.1%.Conclusion: The anatomical relationship between the nose region is more complex, with nerve and vessel important running, the traditional nasal lateral incision operation risk, endoscopic anterior skull base tumor resection has good operating field exposure, adequate light, small trauma, resection range and other advantages, can effectively guarantee the survival rate of patients, to reduce the risk of recurrence, is a safe, effective treatment, can be popularized in surgical treatment.
, 百拇医药
Keywords: nose; anatomy; nasal endoscope; m alignant tumor; treatment
鼻前颅底恶性肿瘤的高发区域为鼻腔及鼻窦,该部位解剖结构与眼眶、大脑额叶等结构毗邻,患者可表现为顽固性头痛、视力下降和眼肌麻痹等症状[1]。目前鼻前颅底肿瘤的常用治疗方法为传统的鼻侧切开术,创伤较大,不利于患者的美观。20世纪70年代鼻内镜技术逐渐得到了广泛应用,但由于鼻前颅底解剖结构复杂,手术难度极大[2]。为详细分析鼻前颅底的解剖学特点,并分析鼻内镜在对该部位恶性肿瘤治疗中的应用,笔者进行了相关分析,现报道如下:
1材料与方法
1.1临床资料
选取我院2008年9月~2010年9月收治的71例鼻前颅底恶性肿瘤患者,均经CT、MRI及病理组织学检查确诊[3],排除:癌细胞已侵袭脑实质、额窦前外侧壁或眶内组织。其中男性59例,女性12例,年龄28~63岁,平均(49.2±8.4)岁,病理类型:嗅神经母细胞瘤21例,恶性黑色素瘤17例,鳞状细胞癌11例,脊索瘤10例,黏液表皮样癌8例,蝶筛窦腺癌4例;治疗史:9例患者曾接受手术治疗,13例患者曾接受手术+化疗,8例患者接受手术+放疗,其他患者均为首次确诊。并选取20例尸头标本,不分性别,排除:①发现鼻部或鼻窦畸形;②死亡前存在面部外伤或面部手术史。将上述20例标本分为解剖组及鼻内镜组,每组各10例,分别在局部解剖及鼻内镜下观察其解剖学特点。
, 百拇医药
1.2手术方法
按照患者病理类型选择合适的术式进行鼻内镜下切除:①嗅神经母细胞瘤:对Kadish分期为A、B期患者可仅实施鼻内镜下肿瘤切除及邻近组织清扫[4],对C期患者予以术前放疗,剂量50 Gy,待CT、MRI下显示肿瘤区域减小后实施肿瘤全切。术后全部嗅神经母细胞瘤患者均接受放疗,放疗剂量50~60 Gy,视其实际情况而定;②恶性黑色素瘤:若肿瘤未侵犯颅底骨质,可仅将肿瘤及安全缘切除,若肿瘤对颅底骨质造成侵犯,则使用磨钻自肿瘤侵犯位置将骨质钻开,并将筛骨纸样板切除,暴露肿瘤,实施切除。术后患者接受辅助放疗;③鳞状细胞癌、黏液表皮样癌、蝶筛窦腺癌:可实施鼻内镜下肿瘤组织安全缘范围内完整切除,并于术后实施辅助放疗;④脊索瘤:切除鼻中隔后部,分层切除肿瘤,并使用双极电凝处理肿瘤周边组织,若发现患者存在颅底骨质缺损,则在肿瘤全切后行黏膜瓣修补,术后亦实施辅助放疗。, 百拇医药(陆璐 卢永田 王晓彬)
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