CAJ | 학술논문

目的探讨侧颅底恶性肿瘤侵犯颞骨内段颈内动脉行手术切除后血管重建的可行性.方法分析4例侧颅底恶性肿瘤侵犯颈内动脉岩骨段患者的临床资料,所有患者术前均行颅底MRI、CT及血管造影检查,发现颈内动脉岩骨垂直段骨管骨质破坏,管壁受肿瘤侵犯,管腔狭窄明显.术中彻底切除侧颅底肿瘤及受侵犯的颈内动脉岩骨垂直段后,采用大隐静脉一期重建切除的颈内动脉,同时采用组织瓣覆盖,修复侧颅底缺损,保护重建的颈内动脉.术后所有患者均给予同步放化疗.3例行颞骨扩大全切除术,1例行次全切除术;面神经后移1例,面神经切除后修复3例;受侵乙状窦、颈静脉孔区切除3例;受侵硬脑膜切除并修补3例;游离腹直肌肌皮瓣修复侧颅底缺损3例,带蒂背阔肌肌皮瓣修复缺损1例.结果 4例患者术后均未出现局部及颅脑并发症,组织瓣存活良好,伤口Ⅰ期愈合.术后3～4个月行血管造影检查,显示重建的颈内动脉通畅.本组4例患者中1例术后1年因肿瘤复发死亡,1例术后3年肿瘤复发,带瘤生存至今,2例无瘤生存超过5年.结论运用大隐静脉重建颈内动脉岩骨段的技术为彻底切除侵犯颈内动脉的侧颅底恶性肿瘤提供可能,可避免因颈内动脉切除而引起的神经系统并发症,手术联合术后同步放化疗能提高患者的生存率及生活质量.
목적 탐토측로저악성종류침범섭골내단경내동맥행수술절제후혈관중건적가행성.방법 분석4례측로저악성종류침범경내동맥암골단환자적림상자료,소유환자술전균행로저MRI、CT급혈관조영검사,발현경내동맥암골수직단골관골질파배,관벽수종류침범,관강협착명현.술중철저절제측로저종류급수침범적경내동맥암골수직단후,채용대은정맥일기중건절제적경내동맥,동시채용조직판복개,수복측로저결손,보호중건적경내동맥.술후소유환자균급여동보방화료.3례행섭골확대전절제술,1례행차전절제술;면신경후이1례,면신경절제후수복3례;수침을상두、경정맥공구절제3례;수침경뇌막절제병수보3례;유리복직기기피판수복측로저결손3례,대체배활기기피판수복결손1례.결과 4례환자술후균미출현국부급로뇌병발증,조직판존활량호,상구Ⅰ기유합.술후3～4개월행혈관조영검사,현시중건적경내동맥통창.본조4례환자중1례술후1년인종류복발사망,1례술후3년종류복발,대류생존지금,2례무류생존초과5년.결론 운용대은정맥중건경내동맥암골단적기술위철저절제침범경내동맥적측로저악성종류제공가능,가피면인경내동맥절제이인기적신경계통병발증,수술연합술후동보방화료능제고환자적생존솔급생활질량.
Objective To investigate the feasibility of reconstruction of internal carotid artery after ablation of malignant tumors in lateral skull base.Methods Four male patients with malignant tumors in lateral skull base involved internal carotid artery underwent surgical treatment during Jan 2006 to Jan 2009 were retrospectively analyzed.MRI,CT and DSA were performed in all patients and showed that petrous internal carotid arteries (PICAs) were invaded,with luminal narrow.After radical dissection of tumors and the invaded PICAs,saphenous veins were used to reconstruct the PICAs.All cases were applied with postoperative concomitant radiachemotherapy.Three cases underwent total resection of temporal bone and one case underwent sub-total resection of temporal bone.Retrusion of facial nerve was performed in one case and reconstruction of facial nerve in three cases; Resection of sigmoid sinus and jugular foramen was performed in three cases.Resection and repair of meninges were performed in three cases.Free abdominal rectus and latissimus dorsi muscle myocutaneous flaps were used to repair the defect of lateral skull base and the flaps were well survived.Results No significant neurovascular complications occurred in the patients.Postoperative DSA showed that the reconstructed PICAs were in well conditions.Follow up showed two patients survived tumor-free for five years,one patient had recurrence three years after operation and survived with tumor,and one patient died of recurrence one year after operation.Conclusions Reconstruction of PICA by aphenous vein offered the possibility of radical resection of malignant tumors in lateral skull base involved PICAs.