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目的总结经颅鼻眶入路治疗筛窦恶性肿瘤的临床经验。方法回顾性分析39例经颅鼻眶入路手术切除侵犯前颅凹及眼眶的筛窦恶性肿瘤的临床资料。39例中男29例,女10例,年龄20～65岁,平均42岁;肿瘤类型包括嗅母细胞瘤10例、腺癌8例、鳞癌7例、乳头状瘤6例、肉瘤4例、未分化癌3例、基底细胞癌1例。38例肿瘤侵犯前颅凹,其中31例侵犯眼眶、5例侵犯翼腭窝、3例侵犯中颅凹及海绵窦。临床表现包括鼻堵、鼻溢、鼻衄、鼻部肿物,突眼、视力下降,面部麻木,意识障碍等。结果肿瘤全切除32例(其中包括9例完整摘除),近全切除7例。术后一过性脑脊液鼻漏5例,无颅内及切口感染。随访到27例(77.1%),随访时间为3个月至7年,平均3年6个月。肿瘤局部复发8例,肺部转移1例。术后1个月至6年死亡4例。结论经颅鼻眶入路充分显露侵犯前颅凹及眼眶部的筛窦肿瘤,且能完整切除肿瘤,手术安全,并发症少。
Objective To summarize the clinical experience of transcranial orbital approach in the treatment of ethmoid malignant tumors. Methods A retrospective analysis of 39 cases of transcranial orbital approach resection of anterior fundus and orbital malignancy of ethmoid sinus clinical data. There were 29 males and 10 females in 39 cases, ranging in age from 20 to 65 years (mean 42 years). The tumor types included 10 cases of olfactory cell tumors, 8 cases of adenocarcinoma, 7 cases of squamous cell carcinoma, 6 cases of papilloma, 4 cases of sarcoma , Undifferentiated carcinoma in 3 cases, basal cell carcinoma in 1 case. 38 cases of tumor invasion of the anterior cranial recess, of which 31 cases of orbital encroachment, 5 cases of invasion of the pterygopalatine fossa, 3 cases of invasion of the midcave and cavernous sinus. Clinical manifestations include nasal congestion, rhinorrhea, epistaxis, nasal masses, exophthalmos, decreased vision, facial numbness, disturbance of consciousness and the like. Results Tumor resection in 32 cases (including 9 cases of complete removal), nearly total resection in 7 cases. Postoperative transient cerebrospinal fluid rhinorrhea in 5 cases, no intracranial and incision infection. Follow-up to 27 cases (77.1%), followed up for 3 months to 7 years, an average of 3 years and 6 months. Local tumor recurrence in 8 cases, 1 case of lung metastasis. 4 cases died after 1 month to 6 years. Conclusion The transcranial orbital approach fully exposes the ethmoid sinus tumor that infiltrates the anterior cranial recess and orbit, and can completely remove the tumor. The operation is safe and the complication is less.