本文選題：前顱底　切入點：溝通腫瘤　出處：《北京協和醫(yī)學院》2017年碩士論文　論文類型：學位論文

【摘要】：目的前顱底溝通腫瘤因其位置及解剖結構的特殊性,常常侵犯毗鄰結構,如顱底、鼻竇、眼眶及其周圍的血管神經,手術風險高、難度大,導致此類腫瘤的全切除率低、復發(fā)率高;而且腫瘤切除后顱腔、鼻腔溝通,術后易出現腦脊液漏、顱內感染等嚴重并發(fā)癥,因此前顱底溝通瘤的外科治療成為外科醫(yī)生不斷探索的方向�；仡櫺苑治鑫以�2009年5月到2016年8月收治的38例前顱底溝通腫瘤患者病例資料,探討前顱底溝通腫瘤理想的診療方案與手術方法。方法男性患者19例,女性患者19例。術前所有患者均行MRI、CT檢查,明確腫瘤的性質及侵及范圍,并經多學科討論,明確患者術前是否需要誘導治療、手術方式及術后輔助治療。38例患者我們均采用經改良Derome入路切除腫瘤,術后結合腫瘤切除情況與病理結果,由腫瘤內科、放射治療科完善綜合治療。結果良性腫瘤15例,惡性腫瘤23例;腫瘤全切除32例(84.2%),次全切除6例(15.8%),并發(fā)癥發(fā)生率為31.6%(12/38),無手術死亡病例。38例患者中,2例失訪,其余36例隨訪時間為2-89月,惡性腫瘤的5年生存率為66.2%。結論前顱底區(qū)腫瘤病理類型復雜,其中又以惡性居多(本組中占60.5%),以手術為主的多學科綜合治療可明顯延長患者生存率、提高生活質量;通過經改良Derome入路一期切除前顱底溝通腫瘤,可避免面部疤痕、增加根治性切除腫瘤的幾率;采用顳肌筋膜及帶血管蒂額肌骨膜瓣雙層修復顱底,能明顯降低腦脊液漏及顱內感染等并發(fā)癥的發(fā)生率。術后規(guī)范化綜合治療能提高局部控制率和總體生存率。
[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.
【學位授予單位】：北京協和醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R739.41

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本文編號：1599586