山东大学耳鼻喉眼学报 ›› 2021, Vol. 35 ›› Issue (2): 55-59.doi: 10.6040/j.issn.1673-3770.1.2020.095

• 临床研究 • 上一篇    下一篇

低温等离子辅助经鼻切除前中颅底肿瘤17例

孙川,刘亚群,何双八,张庆翔   

  1. 东南大学医学院附属南京同仁医院/南京同仁耳鼻喉医院 耳鼻咽喉头颈外科, 江苏 南京 211102
  • 发布日期:2021-04-20
  • 通讯作者: 张庆翔. E-mail:zhangqx@njtrh.org

Cryogenic plasma-assisted nasal resection of seventeen cases of anterior and middle skull base tumors

SUN Chuan, LIU Yaqun, HE Shuangba, ZHANG Qingxiang   

  1. Department of Otorhinolaryngology & Head and Neck Surgery, Nanjing Tongren Hospital, School of Medicine, Southeast University/Nanjing Tongren ENT Hospital, Nanjing 211102, Jiangsu, China
  • Published:2021-04-20

摘要: 目的 探讨低温等离子辅助下经鼻前中颅底肿瘤切除的应用效果。 方法 回顾性分析17例运用经鼻低温等离子切除前中颅底肿瘤患者的病历资料。总结该技术应用优点与不足,观察术后并发症情况及治疗效果。 结果 本组病例的术中出血量为70~800 mL,中位数出血量为210 mL;手术时间为50~270 min,中位数手术时间为145 min;住院时间为10~35 d,平均21 d。17例鼻腔鼻窦及颅底肿瘤均进行了彻底切除,术后无颅神经损伤及相关功能障碍出现,无脑脊液鼻漏及颅内感染等并发症。随访(54.9±29.8)个月,3例死亡、1例失访,其余无肿瘤复发。 结论 低温等离子辅助下经鼻前中颅底肿瘤切除术是一种安全有效的辅助措施。

关键词: 颅底肿瘤, 鼻内窥镜, 低温等离子射频, 手术, 并发症

Abstract: Objective To investigate the effect of low-temperature plasma-assisted transnasal middle skull base tumor resection. Methods A retrospective analysis of the medical records of 17 patients with anterior middle skull base tumors excised using intranasal low-temperature plasma was conducted. The advantages and disadvantages of this technique were summarized, and the postoperative complications and therapeutic effects were noted. Results The intraoperative blood loss in this group was 70-800 mL, and the median blood loss was 210 mL. The duration of surgery was 50-270 min, and the median duration of surgery was 145 min. The duration of hospital stay ranged from 10 to 35 days, with an average of 21 days. All the 17 cases of nasal sinus and skull base tumors were completely resected. No cranial nerve injury and related dysfunction and complications, such as cerebrospinal fluid rhinorrhea and intracranial infection, were observed after the surgery. The patients were followed up for 54.9±29.8 months; 3 died, 1 was lost to follow-up, and the rest had no tumor recurrence. Conclusion Low-temperature plasma-assisted transnasal middle skull base tumor resection can safely and effectively reduce intraoperative hemorrhage, the duration of surgery, and postoperative complications.

Key words: Skull base tumor, Nasal endoscope, Radiofrequency coblation, Surgery, complications

中图分类号: 

  • R739.8
[1] Koutourousiou M, Fernandez-Miranda JC, Stefko ST, et al. Endoscopic endonasal surgery for suprasellar meningiomas: experience with 75 patients[J]. J Neurosurg, 2014, 120(6): 1326-1339. doi:10.3171/2014.2.jns13767.
[2] Zwagerman NT, Zenonos G, Lieber S, et al. Endoscopic transnasal skull base surgery: pushing the boundaries[J]. J Neurooncol, 2016, 130(2): 319-330. doi:10.1007/s11060-016-2274-y.
[3] Snyderman CH, Wang EW, Fernandez-Miranda JC, et al. The making of a skull base team and the value of multidisciplinary approach in the management of sinonasal and ventral skull base malignancies[J]. Otolaryngol Clin North Am, 2017, 50(2): 457-465. doi:10.1016/j.otc.2016.12.017.
[4] 张秋航. 内镜颅底外科实践中存在的问题[J]. 中华耳鼻咽喉头颈外科杂志, 2018, 53(4): 241-243. doi:10.3760/cma.j.issn.1673-0860.2018.04.001. ZHANG Qiuhang. The practical problems on endoscopic skull base surgery[J]. Chin J Otorhinolaryngol Head Neck Surg, 2018, 53(4): 241-243. doi:10.3760/cma.j.issn.1673-0860.2018.04.001.
[5] 许庚.经鼻内镜鼻腔鼻窦-颅底肿瘤手术[J].中华耳鼻咽喉头颈外科杂志, 2020, 55(1):4-7. doi:10.3760/cma.j.issn.1673-0860.2020.01.002. XU Geng. Endoscopic surgery for sinonasal and cranial base tumors[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2020, 55(1):4-7. doi:10.3760/cma.j.issn.1673-0860.2020.01.002.
[6] Mangussi-Gomes J, Beer-Furlan A, Balsalobre L, et al. Endoscopic endonasal management of skull base chordomas: surgical technique, nuances, and pitfalls[J]. Otolaryngol Clin North Am, 2016, 49(1): 167-182. doi:10.1016/j.otc.2015.09.011.
[7] 怀德, 殷敏, 张希龙, 等. 低温等离子射频辅助改良腭咽成形联合舌减容、鼻腔扩容术治疗中重度OSAHS[J]. 中国中西医结合耳鼻咽喉科杂志, 2018, 26(4): 281-285. doi:10.16542/j.cnki.issn.1007-4856.2018.04.012. HUAI De, YIN Min, ZHANG Xilong, et al. Observation on the therapeutic effect of modified uvulopalatopharyngoplasty combined tongue volume reduction with selective nasal cavity dilatation assisted by low-temperature plasma ablation on moderately severe degrees of OSAHS[J]. Chin J Otorhinolaryngol Integr Med, 2018, 26(4): 281-285. doi:10.16542/j.cnki.issn.1007-4856.2018.04.012.
[8] Duarte VM, Liu YF, Shapiro NL. Coblation total tonsillectomy and adenoidectomy versus coblation partial intracapsular tonsillectomy and adenoidectomy in children[J]. Laryngoscope, 2014, 124(8): 1959-1964. doi:10.1002/lary.24632.
[9] 刘学军, 黄赛瑜, 高金建, 等. 鼻内镜下低温等离子射频消融术治疗儿童鼾症的疗效及术后反应观察[J]. 中国内镜杂志, 2016, 22(6): 5-8. doi:10.3969/j.issn.1007-1989.2016.06.002. XUEJUN Liu, SAIYU Huang, JINJIAN Gao, et al. Effect and postoperative reaction of nasal endoscopic low temperature plasma radiofrequency ablation on children with snoring[J]. China J Endosc, 2016, 22(6): 5-8. doi:10.3969/j.issn.1007-1989.2016.06.002.
[10] 祝康, 何莹, 闫静, 等. 鼻内镜下低温等离子射频手术治疗鼻腔鼻窦良性肿瘤[J]. 山东大学耳鼻喉眼学报, 2015(2): 62-64. doi:10.6040/j.issn.1673-3770.0.2014.337. ZHU Kang, HE Ying, YAN Jing, et al. Nasal endoscopy by low-temperature plasma radiofrequency for benign tumor resection[J]. J Otolaryngol Ophthalmol Shandong Univ, 2015(2): 62-64. doi:10.6040/j.issn.1673-3770.0.2014.337.
[11] Lee JY, Lee JD. Comparative study on the long-term effectiveness between coblation- and microdebrider-assisted partial turbinoplasty[J]. Laryngoscope, 2006, 116(5): 729-734. doi:10.1097/01.mLg.0000205140.44181.45.
[12] Syed MI, Mennie J, Williams AT. Early experience of radio frequency coblation in the management of intranasal and sinus tumors[J]. Laryngoscope, 2012, 122(2): 436-439. doi:10.1002/lary.22420.
[13] Windfuhr JP, Savva K, Dahm JD, et al. Tonsillotomy: facts and fiction[J]. Eur Arch Otorhinolaryngol, 2015, 272(4): 949-969. doi:10.1007/s00405-014-3010-x.
[14] Maroulis I, Spyropoulos C, Kalogeropoulou C, et al. Use of radiofrequency ablation for controlling liver hemorrhage in the emergency setting; report of two cases and review of the literature[J]. Turkish J Trauma Emerg Surg: TJTES, 2013, 19(2): 167-172. doi:10.5505/tjtes.2013.22567.
[1] 李定波,唐志元,邓智毅,曾宪海,张秋航,王再兴. 低温等离子射频消融术治疗药物性鼻炎27例[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 11-17.
[2] 李丹凤,陈福权,石力,王剑,许敏. 三维影像处理结合影像导航技术在进修医生鼻科围手术期教学中的应用[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 113-118.
[3] 龚霄阳,李旺,陈曦. 原发性咽旁间隙肿瘤67例回顾性分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 60-65.
[4] 张丰珍, 王桂香, 魏沄沄, 张亚梅, 赵靖, 王华, 李宏彬, 李晓丹, 张杰. 合并轻度出血性疾病的扁桃体和(或)腺样体切除术患儿围手术期管理[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 66-72.
[5] 张礼俊, 胥然, 罗继芳, 刘国旗, 何千, 李玮, 蒋振华. 头颈肿瘤游离皮瓣修复术后皮瓣坏死及皮瓣相关并发症影响因素分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 86-90.
[6] 王欢,胡俐,余洪猛. 慢性鼻窦炎相关嗅觉功能障碍研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 43-49.
[7] 资昊坤,肖旭平,李云秋. 口服糖皮质激素在慢性鼻窦炎伴鼻息肉围手术期的应用现状[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 98-103.
[8] 曹轩,肖旭平,李云秋. 透明质酸在慢性鼻窦炎中的研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 104-109.
[9] 秦铭,孙占伟,王卫卫,李世超,武天义,王广科. 咽喉反流症状或体征评分阳性的慢性鼻窦炎患者鼻内镜术后碱性等渗盐水冲洗的疗效观察[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 147-153.
[10] 陈世琴,卫平存,胡云龙,胡金旺. 糖皮质激素三种不同鼻用法对鼻内镜术后黏膜转归的影响[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 195-201.
[11] 赵笑冰,张大为,陈仁杰. 中耳间变性大T细胞淋巴瘤1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2022, 36(2): 7-14.
[12] 冯燚源,杨晶,杨洪斌. 220例颈深间隙感染临床分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(2): 51-57.
[13] 杨扬, 王晓旭, 张杰. 儿童中耳胆脂瘤诊治进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 1-6.
[14] 陈坤,陆慧,黄琦,李磊,孟国珍,杨军,侯东明. 小儿先天性鼻腔鼻窦肿物的临床诊疗观察[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 81-85.
[15] 李莹. 重视角膜屈光手术操作规范及并发症防治[J]. 山东大学耳鼻喉眼学报, 2021, 35(6): 1-6.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 杨长亮,黄治物,姚行齐,诸勇,孙艺 . 正常气骨导听性脑干反应及其应用[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 9 -13 .
[2] 曹忠良 . 颌面复合伤155例临床分析[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 89 -89 .
[3] 毕景云 . 鼻中隔矫正术后血肿的处理[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 90 -91 .
[4] 刘大昱,潘新良,雷大鹏,许风雷,张立强,栾信庸 . 梨状窝内侧壁癌的手术治疗[J]. 山东大学耳鼻喉眼学报, 2007, 21(1): 8 -11 .
[5] 楼正才 . 掌拳击伤鼓膜损伤机制及临床特点分析[J]. 山东大学耳鼻喉眼学报, 2008, 22(2): 188 -188 .
[6] 刘 艳,刘新义,王金平,李大健 . 后鼓室解剖结构测量观察及临床意义[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 218 -221 .
[7] 赵 敏,王守森,甄泽年,陈贤明,王茂鑫 . 鼻内镜联合显微镜行蝶窦及经蝶鞍区微创手术[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 244 -245 .
[8] 伦 杰,吕心红 . 鼻部脂溢性角化病1例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 252 -252 .
[9] 王红霞,王鹏程 . NSE、S100及GFAP在视网膜母细胞瘤中的表达及意义[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 263 -264 .
[10] 黄 方,黄海琼,黄建强,何荷蕃 . 支气管内镜视频监视系统在小儿气管-支气管异物诊治中的应用[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 276 -277 .