内镜经鼻入路切除颅底软骨肉瘤的临床分析
Clinical analysis of endoscopic transnasal resection of skull base chondrosarcoma
杨晓彤 1严波 1危维 1刘俊其 1王振霖1
作者信息
- 1. 首都医科大学宣武医院耳鼻咽喉头颈外科颅底外科中心(北京,100053)
- 折叠
摘要
目的:探讨内镜经鼻入路处理颅底软骨肉瘤的手术技术及临床效果.方法:收集2013-2022年在首都医科大学宣武医院耳鼻咽喉头颈外科诊断为颅底软骨肉瘤并接受内镜经鼻手术的患者资料.回顾性分析患者的临床表现、病理学分级、累及部位和范围及内镜经鼻手术治疗后的并发症情况,并采用Kaplan-Meier法统计其无病生存率.结果:资料完整的31例患者中,主体位于岩斜区27例(87％),累及前颅底4例(13％).病理分级Ⅰ级(12例),Ⅱ级(16例),Ⅲ(3例).其中,25例实现了影像学全切,6例术后残留.术后平均随访时间为35.7个月(6～120个月),在全切病例中有5例复发(5/25),5年的无瘤生存率为80％.6例患者在术后出现一过性外展神经麻痹,4例出现脑脊液鼻漏.无死亡病例和永久的颅神经麻痹.全切率(P=0.001)和累及桥小脑角、颈静脉孔(P=0.037)是影响软骨肉瘤残留、复发的独立危险因素.结论:内镜经鼻入路手术是处理颅底软骨肉瘤较为安全、可行的治疗方式.
Abstract
Objective:To explore the surgical techniques and clinical outcomes of endoscopic transnasal approa-ches in the treatment of skull base chondrosarcomas.Methods:Data from patients diagnosed with skull base chon-drosarcomas and treated via endoscopic transnasal surgery at the Department of Otorhinolaryngology and Head and Neck Surgery,Xuanwu Hospital,Capital Medical University,from 2013 to 2022 were collected.This retro-spective study analyzed the patients'clinical presentations,histopathological grading,involved sites and extents,and complications following the endoscopic transnasal surgery.Disease-free survival rates were calculated using the Kaplan-Meier method.Results:Complete data from 31 patients showed that the primary tumor site was in the petroclival region in 27 cases(87％),and the anterior skull base in 4 cases(13％).Pathological grades were GradeⅠ(12 cases),Grade Ⅱ(16 cases),and Grade Ⅲ(3 cases).Total resection was achieved in 25 cases,with residual disease post-surgery in 6 cases.The average follow-up duration was 35.7 months(ranging from 6 to 120 months).Among those who achieved complete resection,recurrence occurred in 5 cases(5/25),with a five-year disease-free survival rate of 80％.Postoperative complications included transient abducens nerve palsy in 6 patients and cere-brospinal fluid rhinorrhea in 4 patients.There were no cases of death or permanent cranial nerve palsy.Total re-section rate(P=0.001)and involvement of the cerebellopontine angle and jugular foramen(P=0.037)were iden-tified as independent risk factors for residual disease and recurrence of chondrosarcoma.Conclusion:The endo-scopic transnasal approach is a safe and feasible treatment option for skull base chondrosarcomas.
关键词
内镜入路/手术/颅底/软骨肉瘤/并发症Key words
endoscopic approach/surgery/skull base/chondrosarcoma/complications引用本文复制引用
出版年
2024
NETL
NSTL
万方数据