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目的总结采用内镜经鼻入路外科治疗斜坡肿瘤的初步经验。方法 2002年8月至2005年11月,对24例斜坡病变患者行内镜经鼻手术,其中脊索瘤5例,骨纤维异常增殖症2例,脑膜瘤1例,颅咽管瘤1例,血管母细胞瘤1例,鳞状细胞癌6例,脊索肉瘤2例,软骨肉瘤2例,恶性淋巴瘤1例,腮腺癌颅底转移1例,甲状腺癌颅底转移1例,恶性骨巨细胞瘤1例。结果 24例患者术中镜下及术后影像学检查显示肿瘤完全切除22例,次全切除2例。所有病例随访12～51个月,有3例死亡。完全切除的22例中,术后5例复发,其中2例分别手术后5个月和43个月行第2次内镜经鼻手术,前者于第2次手术后26个月死亡,后者至今生仔。1例手术后18个月行经颅手术;2例分别于术后38个月和术后12个月复发,未行治疗,带瘤生存。次全切除的2例中,1例脊索肉瘤患者手术后3个月死亡;另1例术前曾行经颅手术,颅内中脑前方有瘤组织残留,手术后5个月死亡。术后并发症包括蛛网膜下腔出血1例、脑脊液鼻漏2例,无颅内感染病例。结论内镜经鼻治疗斜坡肿瘤不仅微创,而且可以更好地辨认深部结构,暴露和处理病变的范围大。同时,可以简单迅速地到达斜坡区域。内镜经鼻对于斜坡病变是一种较好的手术入路。
Objective To summarize the preliminary experience of endoscopic transnasal approach for surgical treatment of sloped tumors. Methods From August 2002 to November 2005, 24 patients with slope disease underwent endoscopic nasal surgery. Among them, 5 were chordoma, 2 were fibrous dysplasia, 1 was meningioma, 1 was craniopharyngioma, 1 case of hemangioblastoma, 6 cases of squamous cell carcinoma, 2 cases of chorda sarcoma, 2 cases of chondrosarcoma, 1 case of malignant lymphoma, 1 case of parotid gland metastasis of skull base, 1 case of thyroid carcinoma skull base metastasis, 1 case of tumor. Results 24 cases of patients underwent microscopic and postoperative imaging examination showed complete tumor resection in 22 cases, subtotal resection in 2 cases. All cases were followed up for 12 to 51 months, with 3 deaths. Of the 22 patients who underwent complete resection, 5 patients relapsed after operation, of which 2 patients underwent second endoscopic nasal surgery at 5 months and 43 months respectively. The former died 26 months after the second operation. Aberdeen to this day. One patient underwent craniotomy 18 months after surgery. Two patients relapsed 38 months after operation and 12 months after operation, respectively. Among the 2 subtotal resections, 1 patient with chordomas died 3 months after surgery. The other 1 patient underwent transcranial craniotomy before operation. The tumor remained in the front of the intracranial midbrain and died 5 months after the operation. Postoperative complications included 1 case of subarachnoid hemorrhage, 2 cases of cerebrospinal fluid rhinorrhea, and no cases of intracranial infection. Conclusions Endoscopic and nasal treatment of sloped tumors is not only minimally invasive but also allows better identification of deep structures and a wide range of exposure and management of lesions. At the same time, it is easy and quick to reach the slopes. Endoscopic nasal slope surgery is a good surgical approach.