CAJ | 학술논문

目的探讨经鼻内镜蝶窦进路岩尖部胆脂瘤囊内切除术的可行性及疗效.方法回顾性分析2001-2006年经鼻内镜蝶窦进路切除鞍旁、岩尖部胆脂瘤患者3例的临床资料.3例患者均在全麻下经鼻内镜全筛窦、蝶窦开放,于蝶窦外侧壁、颈内动脉前方磨开颅底骨板进入岩尖部,切开并扩大胆脂瘤囊壁后,采用吸引、刮除和冲洗的方法将胆脂瘤进行囊内清除.结果 3例岩尖胆脂瘤经囊内切除手术,均一次清除干净,手术前伴有头痛和眶尖综合征的2例患者于术后当天即有症状改善,术后1～4周症状完全恢复,全部患者未发生手术并发症.术后随访3～7年,全部患者症状未再发,影像学检查胆脂瘤无复发.结论靠近鞍旁区域的岩尖胆脂瘤可以采用经鼻内镜蝶窦进路行囊内切除手术,远期疗效可靠.
목적 탐토경비내경접두진로암첨부담지류낭내절제술적가행성급료효.방법 회고성분석2001-2006년경비내경접두진로절제안방、암첨부담지류환자3례적림상자료.3례환자균재전마하경비내경전사두、접두개방,우접두외측벽、경내동맥전방마개로저골판진입암첨부,절개병확대담지류낭벽후,채용흡인、괄제화충세적방법장담지류진행낭내청제.결과 3례암첨담지류경낭내절제수술,균일차청제간정,수술전반유두통화광첨종합정적2례환자우술후당천즉유증상개선,술후1～4주증상완전회복,전부환자미발생수술병발증.술후수방3～7년,전부환자증상미재발,영상학검사담지류무복발.결론 고근안방구역적암첨담지류가이채용경비내경접두진로행낭내절제수술,원기료효가고.
Objective To introduce our experience of resection of petrous apex cholesteatoma through endoscopic,transnasal,trans-sphenoidal approach in 3 cases,and present a surgical technique of intracystic resection of lesion which yielded a relatively stable long-term outcome.Methods Resection of parasellar and petrous apex cholesteatoma via endoscopic transsphenoidal approach was performed in three patients between 2001 and 2006.Surgical technique was as follows: the ethmoid and sphenoid sinuses were opened under endoscope,the petrous apex was accessed by drilling skull base bone at the lateral wall of sphenoid sinus and anterior to the internal carotid artery,the cyst wall of cholesteatoma was incised and expanded,then intracystic removal of cholesteatoma was achieved by the suction,curette and rinsing.Results The petrous apex cholesteatoma in all 3 patients were removed clearly by endoscopic,transnasal,trans-sphenoidal surgery in one time.Before surgery,two patients with headache and orbital apex syndrome had a remarkable improvement just on the day after operation and completely recovered in 1-4 weeks.No postoperative complications happened in all three patients.All patients had no recurrence in symptoms and no imaging evidences of recurrence at a follow-up of 3-7 years. Conclusion The petrous apex cholesteatoma around the parasellar region could be treated by intracystic removal via endoscopic,transnasal,transsphenoidal approach,without the need to strip and remove the cyst wall,and the long-term efficacy was reliable.