经鼻内窥镜手术后颅底重建的进展

Shuai Tang, Gang Yang
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摘要

内窥镜经鼻方法在短短几十年间经历了快速发展和逐渐成熟(Kassam AB、Prevedello DM、Carrau RL 等人,2011 年;Eloy J A、Vivero R J、Hoang K 等人,2009 年)。这种方法已从切除传统垂体瘤扩展到应用内窥镜扩展经蝶窦方法切除鞘内、鞘上甚至脑室系统的肿瘤(Cappabianca P、Cavallo L M、Esposito F等人,2008年)。颅底骨质和硬脑膜缺损较大,会引起更严重的术后并发症,导致医疗负担倍增(Eloy J A、Shukla P A、Choudhry O J 等人,2013 年)。肿瘤切除后的颅底重建已成为一项巨大挑战。目前,颅底重建主要分为软性重建和硬性重建,软性重建以带蒂鼻中隔粘膜瓣(PNSF)技术为代表(Thorp B D, Sreenath S B, Ebert C S, et al, 2014)0。 至于硬性重建,目前仍存在争议(Shin J, Forbes J, Lehner K, et al, 2019; Eloy J A, Shukla P A, Choudhry O J, et al, 2012)。从目前的研究来看,刚性重建具有不可忽视的作用。本文将介绍颅底外科的发展以及几种备受瞩目的颅底重建技术。
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Advances in Skull Base Reconstruction After Transnasal Endoscopy
Endoscopic transnasal approach have experienced rapid development and gradual maturation in just a few decades (Kassam AB, Prevedello DM, Carrau RL, et al, 2011; Eloy J A, Vivero R J, Hoang K, et al, 2009). It has expanded from the removal of conventional pituitary tumours to the application of an endoscopic extended transsphenoidal approach for the resection of tumours in the intrasellar, suprasellar and even ventricular systems (Cappabianca P, Cavallo L M, Esposito F, et al, 2008). Larger bone and dural defects at the skull base, causing more severe postoperative complications and resulting in a multiplication of the healthcare burden (Eloy J A, Shukla P A, Choudhry O J, et al, 2013). Skull base Reconstruction after tumour removal has become a great challenge. Currently, skull base reconstruction is mainly divided into soft and rigid reconstruction, and soft reconstruction is represented by the technique of pedicled nasal septum mucosal flap (PNSF) (Thorp B D, Sreenath S B, Ebert C S, et al, 2014)0. As for rigid reconstruction, it is still controversial (Shin J, Forbes J, Lehner K, et al, 2019; Eloy J A, Shukla P A, Choudhry O J, et al, 2012). From the current studies, rigid reconstruction has a role that cannot be ignored. In this article, we will describe the development of skull base surgery and several high-profile skull base reconstruction techniques.
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