低温等离子辅助经鼻切除前中颅底肿瘤17例

doi:10.6040/j.issn.1673-3770.1.2020.095

摘要/Abstract

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

孙川,刘亚群,何双八,张庆翔. 低温等离子辅助经鼻切除前中颅底肿瘤17例[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 55-59.

SUN Chuan, LIU Yaqun, HE Shuangba, ZHANG Qingxiang. Cryogenic plasma-assisted nasal resection of seventeen cases of anterior and middle skull base tumors[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(2): 55-59.

参考文献

[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.

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