• 1 四川大學(xué)華西醫(yī)院神經(jīng)外科（成都，610041）;;
  • 2 廣西中醫(yī)學(xué)院附屬瑞康醫(yī)院神經(jīng)外科;

目的 總結(jié)顱眶溝通性腫瘤切除術(shù)中顱眶重建方法及圍手術(shù)期護(hù)理經(jīng)驗。 方法 2008 年4 月－
2011 年4 月，收治35 例顱眶溝通性腫瘤患者。男21 例，女14 例；年齡17 ～ 73 歲，平均46.3 歲。以眼眶脹痛為首發(fā)癥
狀者13 例，視力下降12 例，眼球突出或眼位不正5 例，頭痛、頭暈2 例，復(fù)視2 例，眼球搏動1 例。術(shù)中切除病變后采用
自體骨片及鈦網(wǎng)、額骨骨膜瓣、人工硬腦膜、醫(yī)用耳腦膠等材料進(jìn)行顱眶重建，術(shù)后重視顱內(nèi)壓管理并預(yù)防并發(fā)癥發(fā)生。
結(jié)果 術(shù)后3 d，MRI 檢查示腫瘤全切除30 例，次全切除3 例，大部切除2 例。無手術(shù)相關(guān)死亡發(fā)生。術(shù)后1 周內(nèi)發(fā)生腦
脊液眼漏1 例及術(shù)區(qū)感染2 例，分別經(jīng)腰大池持續(xù)引流10 d 及抗生素治療后治愈?；颊呔@隨訪，隨訪時間6 ～ 36 個月，
平均18 個月。9 例視力下降者術(shù)后1 個月好轉(zhuǎn)；眼眶脹痛者術(shù)后2 周內(nèi)明顯緩解；眼球突出或眼位不正及眼球搏動等癥
狀術(shù)后均消失。27 例良性腫瘤患者24 例痊愈，隨訪期間無復(fù)發(fā)；8 例惡性腫瘤患者18 個月內(nèi)復(fù)發(fā)6 例，行二次手術(shù)或放
療，其中2 例于術(shù)后24 個月死于腫瘤所致腦疝及呼吸循環(huán)衰竭。無眼球凹陷、搏動性突眼、顴部塌陷等并發(fā)癥發(fā)生。 結(jié)
論 采用自體骨片及鈦網(wǎng)、額骨骨膜瓣、人工硬腦膜、醫(yī)用耳腦膠等材料進(jìn)行顱眶溝通性腫瘤切除后顱眶重建，具有穩(wěn)固
可靠、操作簡便、易達(dá)解剖重建等特點，配合圍手術(shù)期護(hù)理，可以取得較好手術(shù)效果。

引用本文： 蔣艷 ,劉家剛,范學(xué)政,蔡博文. 顱眶溝通性腫瘤顱眶重建及圍手術(shù)期處理. 中國修復(fù)重建外科雜志, 2012, 26(5): 567-570. doi: 復(fù)制

1. Eppley BL. Craniofacial with computer generated htr patient matched implants use in primary bone tumor excision. J Craniofac Surg, 2002, 13(5): 650-657.
2. Hanasono MM, Silva A, Skoracki RJ, et al. Skull base reconstruction: an updated approach. Plast Reconstr Surg, 2011, 128(3): 675-686.
3. Young TK, Hardy TG. Solitary fibrous tumor of the orbit with intracranial involvement. Ophthal Plast Reconstr Surg, 2011, 27(3): e74-76.
4. 房居高, 韓德民, 倪鑫, 等. 顱內(nèi)外溝通性腫瘤的外科治療. 中國耳鼻咽喉頭頸外科, 2005, 12(11): 701-703.
5. 蔡博文, 周良學(xué), 安惠民, 等. 顱鼻溝通性腫瘤一期聯(lián)合手術(shù)及顱底重建的早期療效. 中國修復(fù)重建外科雜志, 2008, 22(5): 589-592.
6. Banks CA, Palmer JN, Chiu AG, et al. Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years. Otolaryngol Head Neck Surg, 2009, 140(6): 826-833.
7. Gagliardi F, Boari N, Mortini P. Reconstruction techniques in skull base surgery. J Craniofac Surg, 2011, 22(3): 1015-1020.
8. Ascherman JA, Foo R, Nanda D. Reconstruction of cranial bone defects using a quick-setting hydroxyapatite cement and absorbable plates. J Craniofac Surg, 2008, 19(4): 1131-1135.
9. Avcu N, Kansu O, Uysal S, et al. Cranio-orbital-temporal neurofibromatosis with cerebral hemiatrophy presenting as an intraoral mass: a case report. J Calif Dent Assoc, 2009, 37(2): 119-121.
10. Shonka DC Jr, Potash AE, Jameson MJ, et al. Successful reconstruction of scalp and skull defects: Lessons learned from a large series. Laryngoscope, 2011, 121(11): 2305-2312.
11. Zwahlen RA, Grätz KW, Obwegeser JA. The galea fascia flap in orbital reconstruction: innovative harvest technique. Eur J Surg Oncol, 2006, 32(7): 804-807.
12. Baujat B, Krastinova-Lolov D, Blumen M, et al. Radiofrequency in the treatment of craniofacial plexiform neurofibromatosis: a pilot study. Plast Reconstr Surg, 2006, 117(4): 1261-1268.
13. Marmulla R, Hoppe H, Mühling J, et al. New augmented reality concepts for craniofacial surgical procedures. Plast Reconstr Surg, 2005, 115(4): 1124-1128.
14. Pinheiro-Neto CD, Ramos HF, Peris-Celda M, et al. Study of the nasoseptal flap for endoscopic anterior cranial base reconstruction. Laryngoscope, 2011, 121(12): 2514-2520.
15. Yazici B, Bilge AD, Yazici Z, et al. Congenital cranio-orbital myofibroma. Ophthal Plast Reconstr Surg, 2011, 27(4): 108-111.
16. Lee KY, Ang BT, Ng I, et al. Stereotaxy for surgical navigation in orbital surgery. Ophthal Plast Reconstr Surg, 2009, 25(4): 300-302.
17. Lieger O, Richards R, Liu M, et al. Computer-assisted design and manufacture of implants in the late reconstruction of extensive orbital fractures. Arch Facial Plast Surg, 2010, 12(3): 186-191.
18. Neovius E, Engstrand T. Craniofacial reconstruction with bone and biomaterials: review over the last 11 years. J Plast Reconstr Aesthet Surg, 2010, 63(10): 1615-1623.
19. Lübbers HT, Jacobsen C, Könü D, et al. Surgical navigation in cranio-maxillofacial surgery: an evaluation on a child with a cranio-facio-orbital tumour. Br J Oral Maxillofac Surg, 2011, 49(7): 532-537.
20. Clauser L, Polito J, Mandrioli S, et al. Structural fat grafting in complex reconstructive surgery. J Craniofac Surg, 2008, 19(1): 187-191.
21. Erb MH, Uzcategui N, See RF, et al. Orbitotemporal neurofibromatosis: classification and treatment. Orbit, 2007, 26(4): 223-228.
  1. 1. Eppley BL. Craniofacial with computer generated htr patient matched implants use in primary bone tumor excision. J Craniofac Surg, 2002, 13(5): 650-657.
  2. 2. Hanasono MM, Silva A, Skoracki RJ, et al. Skull base reconstruction: an updated approach. Plast Reconstr Surg, 2011, 128(3): 675-686.
  3. 3. Young TK, Hardy TG. Solitary fibrous tumor of the orbit with intracranial involvement. Ophthal Plast Reconstr Surg, 2011, 27(3): e74-76.
  4. 4. 房居高, 韓德民, 倪鑫, 等. 顱內(nèi)外溝通性腫瘤的外科治療. 中國耳鼻咽喉頭頸外科, 2005, 12(11): 701-703.
  5. 5. 蔡博文, 周良學(xué), 安惠民, 等. 顱鼻溝通性腫瘤一期聯(lián)合手術(shù)及顱底重建的早期療效. 中國修復(fù)重建外科雜志, 2008, 22(5): 589-592.
  6. 6. Banks CA, Palmer JN, Chiu AG, et al. Endoscopic closure of CSF rhinorrhea: 193 cases over 21 years. Otolaryngol Head Neck Surg, 2009, 140(6): 826-833.
  7. 7. Gagliardi F, Boari N, Mortini P. Reconstruction techniques in skull base surgery. J Craniofac Surg, 2011, 22(3): 1015-1020.
  8. 8. Ascherman JA, Foo R, Nanda D. Reconstruction of cranial bone defects using a quick-setting hydroxyapatite cement and absorbable plates. J Craniofac Surg, 2008, 19(4): 1131-1135.
  9. 9. Avcu N, Kansu O, Uysal S, et al. Cranio-orbital-temporal neurofibromatosis with cerebral hemiatrophy presenting as an intraoral mass: a case report. J Calif Dent Assoc, 2009, 37(2): 119-121.
  10. 10. Shonka DC Jr, Potash AE, Jameson MJ, et al. Successful reconstruction of scalp and skull defects: Lessons learned from a large series. Laryngoscope, 2011, 121(11): 2305-2312.
  11. 11. Zwahlen RA, Grätz KW, Obwegeser JA. The galea fascia flap in orbital reconstruction: innovative harvest technique. Eur J Surg Oncol, 2006, 32(7): 804-807.
  12. 12. Baujat B, Krastinova-Lolov D, Blumen M, et al. Radiofrequency in the treatment of craniofacial plexiform neurofibromatosis: a pilot study. Plast Reconstr Surg, 2006, 117(4): 1261-1268.
  13. 13. Marmulla R, Hoppe H, Mühling J, et al. New augmented reality concepts for craniofacial surgical procedures. Plast Reconstr Surg, 2005, 115(4): 1124-1128.
  14. 14. Pinheiro-Neto CD, Ramos HF, Peris-Celda M, et al. Study of the nasoseptal flap for endoscopic anterior cranial base reconstruction. Laryngoscope, 2011, 121(12): 2514-2520.
  15. 15. Yazici B, Bilge AD, Yazici Z, et al. Congenital cranio-orbital myofibroma. Ophthal Plast Reconstr Surg, 2011, 27(4): 108-111.
  16. 16. Lee KY, Ang BT, Ng I, et al. Stereotaxy for surgical navigation in orbital surgery. Ophthal Plast Reconstr Surg, 2009, 25(4): 300-302.
  17. 17. Lieger O, Richards R, Liu M, et al. Computer-assisted design and manufacture of implants in the late reconstruction of extensive orbital fractures. Arch Facial Plast Surg, 2010, 12(3): 186-191.
  18. 18. Neovius E, Engstrand T. Craniofacial reconstruction with bone and biomaterials: review over the last 11 years. J Plast Reconstr Aesthet Surg, 2010, 63(10): 1615-1623.
  19. 19. Lübbers HT, Jacobsen C, Könü D, et al. Surgical navigation in cranio-maxillofacial surgery: an evaluation on a child with a cranio-facio-orbital tumour. Br J Oral Maxillofac Surg, 2011, 49(7): 532-537.
  20. 20. Clauser L, Polito J, Mandrioli S, et al. Structural fat grafting in complex reconstructive surgery. J Craniofac Surg, 2008, 19(1): 187-191.
  21. 21. Erb MH, Uzcategui N, See RF, et al. Orbitotemporal neurofibromatosis: classification and treatment. Orbit, 2007, 26(4): 223-228.