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目的 探讨上颌骨翻转入路手术切除颅底侵入瘤的指征、手术要点及优缺点。 方法自 1998年 11月～ 2 0 0 1年 8月 ,采用上颌骨翻转入路连续切除鼻咽颅底肿瘤 2 7例 ,对临床资料进行回顾性总结。 结果 2 7例中鼻咽癌 6例 ,鼻咽纤维血管瘤 5例 ,鼻咽囊腺癌 5例 ,神经鞘瘤 2例 ,嗅神经母细胞瘤 2例 ,脊索瘤 2例 ,颞下翼腭窝低分化癌 2例 ,颞下翼腭窝肉瘤 2例 ,上颌窦癌 1例。 18例曾经 1次或多次手术切除肿瘤后复发。侵犯颅内重要结构的 17例。全部患者术中显露满意 ,肿瘤均得到肉眼全切除 ,无手术死亡 ,术后无偏瘫等严重并发症。本组患者术后随访 2～ 3 3个月 ,平均随访16个月。其中 2例分别于术后 5、8个月死于肿瘤复发 ;2例于术后 7、12个月局部复发 ;1例于术后 11个月出现肺转移 ,现带瘤生存 ;其余患者恢复日常生活。 结论 采用上颌骨翻转入路切除原发于颅底、翼腭窝的肿瘤及广泛侵犯颅底的其他鼻咽部肿瘤 ,具有显露充分 ,手术切除彻底的优点。
Objective To investigate the indications, operative points, advantages and disadvantages of maxillary turnover surgery for the removal of skull base invasion tumor. Methods From November 1998 to August 2001, 27 cases of nasopharyngeal skull base tumors were consecutively excised by maxillary inversion approach. The clinical data were retrospectively reviewed. Results There were 6 cases of nasopharyngeal carcinoma, 5 cases of nasopharyngeal fibroadenoma, 5 cases of nasopharyngeal cystadenocarcinoma, 2 cases of schwannoma, 2 cases of olfactory neuroblastoma, 2 cases of chordoma, 2 cases of poorly differentiated carcinoma, 2 cases of temporomandibular fossa sarcoma and 1 case of maxillary sinus cancer. 18 cases had once or more surgical resection of tumor recurrence. 17 violations of intracranial important structure. All patients revealed satisfactory surgery, the tumor were macroscopic resection, no operative death, postoperative hemiplegia and other serious complications. The patients were followed up for 2 to 33 months with a mean follow-up of 16 months. Two of them died of tumor recurrence at 5 and 8 months after operation, 2 patients relapsed locally at 7 and 12 months after operation, 1 patient developed lung metastasis at 11 months after operation, and survived with tumor. The remaining patients recovered Daily life. Conclusion The maxillary turnover approach resection of primary tumors in the skull base, pterygopalatine fossa and other nasopharyngeal tumors with extensive violations of the skull base have the advantages of adequate exposure and complete surgical resection.