累及前颅底肿瘤切除术后的修复重建

•32•3匕京口腔医学2019年第27卷第1期Beijing Journal of Stomatology February2019,Vol.27,No.1累及前颅底肿瘤切除术后的修复重建

冯芝恩Kyojin Kim李博秦力铮李华李建华邢汝东韩正学

【摘要】目的累及前颅底肿瘤术后颅内外沟通缺损的修复重建极具挑战，本研究探讨前颅底缺损修复重建中皮瓣选择、术后短期结果。方法2009年8月至2018年1月，北京口腔医院头颈肿瘤团队完成的累及前颅底的颅内外沟通肿瘤修复重建患者16例纳入本研究。结果16例患者中15例接受带蒂或游离皮瓣修复，其中背阔肌皮瓣6例，带蒂颛肌筋膜瓣4例,腓骨肌皮瓣3例,前臂皮瓣及股前外肌皮瓣各1例，手术成功率100%,未发生严重并发症。结论累及前颅底的颅内外沟通肿瘤修复重建是关乎治疗成败、防止发生致命并发症的关键。颅底缺损范围、颌面软硬组织缺损程度、既往手术及放疗史、皮瓣容积和显微血管条件等均是影响修复重建选择的局部因素。

【关键词】前颅底;颅内外沟通缺损;修复重建;肿瘤;游离皮瓣

【中图号】R739.8【文献标识码】A【文章编号】1006673X(2019)01403245

Reconstruction of the anterior cranial base after resection of the anterior skull base tumor FENG Zhi-en,Kim Kyojin,LI Bo,QIN Li-zheng,LI Hua,LI Jian-hua,XING Ru-dong,HAN Zheng-xue.Department of Oral and Maxillofacial-Head and Neck Oncology,Capital Medical University School of Stomatology,Beijing100050,China [Abstract]Objective To discuss the reconstruction of the anterior skull base after resection of anterior skull base tumor.Methods Clinical data of16patients who received reconstruction of combined intra-extracranial defects involving the anterior skull base with flaps were included in this study.Results Fifteen of16cases underwent reconstruction with pedicle or free flaps among which6cases were latissimus dorsi myocutaneous flap,4cases were pedicle temporalis fascial flap,3 cases were fibula myocutaneous flap,one case was forearm flap,one case was anterolateral thigh flap,the only one patient was without flap(maxillary swing approach after tumor resection and reset).The overall success rate of flaps was100%, and the donor and receient sites were primarily closed,with a low incidence of complications.Conclusion The repair and reconstruction of combined intra-extracranial defects is the key to success of the treatment and the prevention of fatal complications.The size of the defective areas in skull base,the extent of soft and hard tissue defects in the maxillofacial region,the history of previous surgery and radiotherapy,flap volume plus microvascular conditions were all local factors that influence the choice of repair and reconstruction.

[Key words]Anterior skull base；Combined intra-extracranial defects；Repair and reconstruction；Tumor；

Free flap

口腔颌面头颈部或颅内肿瘤造成的颅内外沟通需要口腔颌面外科与神经外科等多学科联合手术,但术后颅底屏障破坏、以及颅颌面部复合组织缺损的修复重建极具挑战，修复失败或选择不当可能造成严重脑脊液漏、颅内积气、脑组织膨出、甚至颅内感染等并发症，进而威胁生命⑴。在口腔颌面外科领域，病变累及前颅底的肿瘤术后修复重建专题报道较少，且多以临床个案为主,因各研究间采用颅底缺损分类不同，造成修复重建设计难以横向对比和

基金项目：国家自然科学基金(81570957)；北京市医院管理局临床医学发展专项(XMLX201819,XMLX201505)；2017年东城区优秀人才项目

作者单位:100050北京首都医科大学口腔医学院口腔颌面头颈肿瘤科

通讯作者:韩正学，E-mail：hanfl989@,电话：010-********缺乏系统阐述。本研究选择本院口腔颌面头颈肿瘤科团队完成的累及前颅底肿瘤术后的颅内外沟通缺损修复重建16例，均按照矢状位缺损分类设计方案，以典型病例分类报道我院前颅底缺损修复重建设计的选择和术后效果。

资料和方法

1.临床资料

2009年8月~2018年1月，首都医科大学附属北京口腔医院口腔颌面头颈肿瘤科团队完成的，累及前颅底肿瘤术后的颅内外沟通缺损患者纳入本项回顾性研究。入选标准:①肿瘤主要累及前颅底，进展达中颅底者，要求颅内外沟通部分主要位于前颅底;②患者接受住院手术治疗;③术前或术后前颅底骨质伴硬脑膜缺损。符合入选标准患者16例，其中男性8例，女性8例；年龄19~67岁，中位年龄43