Objective To analyze the surgical complications of endoscopic nasal-skull base surgery.The secondary objective Was to propose the preliminary strategies for prevention and treatment of complications.Methods One hundred and thirty two patients with nasal-skull base tumors undergoing endoscopic or endoscope-assisted surgery were included in this study.Surgical approaches included endoscopic endonasal transethmoidal approaches,endoscopic endonasal transseptal transsphenoidal approach,extended endoscopic endonasal transseptal transsphenoidal approach,endoscopic transmaxillary posterial wall approach,extended endoscopic transmaxillary posterial wall approach,endoscopic nasal lateral wall dissection,maxillary osteotomy approach and endoscopic transoropharyngeal approach.These approaches were selectively used to resect the tumors in the area of nasal-skull base.Results The total resection of the tumors Was obtained in 104 patients(104/132,78.8%),with 29.5%(39/132)incidence of complications,including profuse bleeding,nerve injury,cerebrospinal fluid leakage,diabetes insipidus,electrolyte imbalance,hyperglycemia,and psychological disturbance.No catastrophic complications,rnsequelae and operative mortality encountered.Four months to 8 years'follow up(median 3.0 years) indicated that recurrence rate of the benign tumor Was 9%(9/100)without died case,and 3-year and 5-year survival rates of the malignant tumor were 75.0%and 55.6%,respectively.Conclusions Strategies proved to be effective in reduction of the overall incidence of the complications,especially in minimizing the catastrophic complications and sequelae.The strategies were as follows:first,according to original site,extension and characteristics of the tumor,designing appropriate endoscopic approaches for the treatment of skull base tumor;second,recognizing reliable surgical access points and safe plane of the dissection;third,rnpredicting surgical risks preoperatively and proposing the corresponding plan to avoid these risks;fourth,rnacquainted with the endoscopic skffis and familiarized the skull base structures;lastly,ensuring the correct management of the interdisciplinary problems with close collaboration with the interdisciplinary medical personnels.%目的 分析鼻相关颅底肿瘤内镜手术并发症,并提出预防和治疗这些并发症的初步策略.方法 鼻相关颅底肿瘤132例,均在内镜下进行手术.根据肿瘤的发生部位、累及范围及性质分别采取经筛、鼻中隔经蝶、扩大鼻中隔经蝶、经上颌窦后壁、扩大上颌窦后壁、鼻腔外侧壁、鼻外上颌骨、经口-咽后壁等手术入路切除肿瘤.结果 肿瘤全切率78.8%(104/132),并发症发生率29.5%(39/132),分别为大出血、神经损伤、脑脊液漏、尿崩、水电解质平衡紊乱、高血糖及神经精神症状,无致残及致死性并发症.随访时间4个月至8年,中位随访时间3.0年.良性肿瘤术后复发率9%(9/100),无死亡病例;Kaplan-Meier法计算恶性肿瘤3年生存率75.O%,5年生存率55.6%.结论 采取合理的手术入路,明确手术的切入点和切除肿瘤的安全平面,并采取恰当的方式切除肿瘤;手术前评估手术风险,并提出处理预案;与其他相关学科之间的密切合作,为正确处理跨学科问题提供技术保证.这些措施对有效减少颅底肿瘤内镜手术并发症,尤其是避免致死和致残性并发症发生具有重要的意义.
展开▼
