Dias F L, Sá G M, Kligerman J, Nogueira J, Galvão M L, Lima R A
Head and Neck Surgery Service, Hospital do Cancer/Instituto Nacional de Cancer, Rio de Janeiro, Brazil.
Arch Otolaryngol Head Neck Surg. 1997 Jul;123(7):738-42. doi: 10.1001/archotol.1997.01900070082013.
We retrospectively reviewed the medical charts of 57 patients with advanced malignant cutaneous tumors involving the anterior skull base who underwent combined craniofacial resection in our department from January 1, 1981, to December 31, 1994.
The data regarding histological results, demographic aspects, clinical presentation, previous treatment, extent of the disease, extent of surgical procedure, type of reconstruction, complications, and follow-up were analyzed using the chi 2 method. Survival analysis was performed using the Kaplan-Meier method.
We found prevalence of the male sex (60%) and white race (86%), with a mean age of 62 years. Thirty-five patients (61%) showed extensive lesions directly invading the anterior skull base (type II); 46 patients (81%) had been treated previously; 10 patients (18%) had dural invasion; 29 patients (51%) could not have the eyeball preserved; 32 patients (56%) underwent microsurgical reconstruction; and 45 patients (79%) underwent pericranial or galeal-pericranial flap reconstruction for the anterior skull base defect. Postoperative complications occurred in 29 patients (51%). The most common complication was postoperative infection (17 patients [59%]). Thirty-two patients (56%) were free of disease, and 4 (7%) were alive with disease at the time of our study.
The extent of facial disease (P = .005) and the type of facial reconstruction (P = .01) were the most important risk factors in the development of infectious complications. Invasion of the dura and the type of reconstruction of the anterior skull base were the most important factors related to cerebrospinal fluid leakage (P = .003) and meningoencephalitis (P = .06). Invasion of the dura mater significantly affected survival (P = .005).
我们回顾性分析了1981年1月1日至1994年12月31日期间在我科接受颅面联合切除术的57例累及前颅底的晚期恶性皮肤肿瘤患者的病历。
采用卡方检验分析组织学结果、人口统计学特征、临床表现、既往治疗、疾病范围、手术范围、重建类型、并发症及随访等数据。采用Kaplan-Meier法进行生存分析。
我们发现男性患病率为60%，白种人患病率为86%，平均年龄为62岁。35例患者（61%）表现为广泛病变直接侵犯前颅底（II型）；46例患者（81%）曾接受过治疗；10例患者（18%）有硬脑膜侵犯；29例患者（51%）无法保留眼球；32例患者（56%）接受了显微外科重建；45例患者（79%）采用颅骨膜或帽状腱膜-颅骨膜瓣修复前颅底缺损。29例患者（51%）发生术后并发症。最常见的并发症是术后感染（17例患者[59%]）。32例患者（56%）无疾病，4例患者（7%）在我们研究时仍患有疾病。
面部疾病范围（P = 0.005）和面部重建类型（P = 0.01）是感染性并发症发生的最重要危险因素。硬脑膜侵犯和前颅底重建类型是与脑脊液漏（P = 0.003）和脑膜脑炎（P = 0.06）相关的最重要因素。硬脑膜侵犯显著影响生存（P = 0.005）。
