Nouraei S A Reza, Ismail Yasmin, Gerber Christopher J, Crawford Peter J, McLean Neil R, Hodgkinson Peter D
London, Liverpool, and Newcastle upon Tyne, United Kingdom; and Adelaide, Australia From the Charing Cross Hospital; Royal Liverpool Hospital; Northern Skull Base and Craniofacial Service, Newcastle General Hospital; and Adelaide Craniofacial Unit.
Plast Reconstr Surg. 2006 Oct;118(5):1151-1158. doi: 10.1097/01.prs.0000236895.28858.4a.
Successful resection of malignant skull base disease depends implicitly on the ability to reconstruct the resulting defects in the craniovisceral diaphragm, to support neural structures, and to prevent ascending intracranial infections. Microsurgery reliably achieves these objectives and has increased the scope of curative oncologic surgery. The authors assessed the reconstructive results and the long-term oncologic outcome of patients having skull base surgery with free tissue transfer.
A retrospective review of cases between 1989 and 2001 was undertaken. Demographics, histology, surgical management, complications, locoregional control, and survival were analyzed.
Predominantly male patients (n = 53; 62 percent) with an average age of 60 years had microvascular reconstruction following oncologic surgery. There was a preponderance of cutaneous malignancies (56 percent), and most lesions involved the anterior skull base (53 percent). Tumors were mostly resected with a combined intracranial or extracranial approach, and reconstruction was undertaken with radial forearm, rectus abdominis, or latissimus dorsi flaps with 94 percent success. Complications occurred in 23 percent of patients, and no specific risk factors for developing intracranial complications were identified. Specifically, extensive reconstructions did not increase the complication rate. The 5-year locoregional control and survival rates were 74 percent and 60 percent, respectively. A positive resection margin significantly increased the risk of locoregional recurrence and worsened disease-specific survival on Cox regression. Survival was also influenced by grade of malignancy.
Microsurgery is highly reliable for reconstructing defects resulting from oncologic resections of the cranial base. It can and should be undertaken using a small number of highly dependable flaps.
成功切除恶性颅底疾病在很大程度上取决于重建颅内脏器膈缺损、支撑神经结构以及预防颅内感染上行的能力。显微外科手术能够可靠地实现这些目标，并扩大了肿瘤根治性手术的范围。作者评估了采用游离组织移植进行颅底手术患者的重建效果和长期肿瘤学结局。
对1989年至2001年期间的病例进行回顾性研究。分析了人口统计学、组织学、手术管理、并发症、局部区域控制和生存率。
主要为男性患者（n = 53；62%），平均年龄60岁，在肿瘤手术后进行了微血管重建。皮肤恶性肿瘤占多数（56%），大多数病变累及前颅底（53%）。肿瘤大多采用颅内或颅外联合入路切除，并用桡侧前臂皮瓣、腹直肌皮瓣或背阔肌皮瓣进行重建，成功率为94%。23%的患者出现并发症，未发现发生颅内并发症的特定危险因素。具体而言，广泛重建并未增加并发症发生率。5年局部区域控制率和生存率分别为74%和60%。切缘阳性在Cox回归分析中显著增加了局部区域复发风险，并使疾病特异性生存率恶化。生存率还受恶性程度分级的影响。
显微外科手术在重建颅底肿瘤切除所致缺损方面高度可靠。可以且应该使用少数高度可靠的皮瓣进行手术。
