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目的总结颅眶沟通性肿瘤切除术中颅眶重建方法及围手术期护理经验。方法 2008年4月-2011年4月,收治35例颅眶沟通性肿瘤患者。男21例,女14例;年龄17～73岁,平均46.3岁。以眼眶胀痛为首发症状者13例,视力下降12例,眼球突出或眼位不正5例,头痛、头晕2例,复视2例,眼球搏动1例。术中切除病变后采用自体骨片及钛网、额骨骨膜瓣、人工硬脑膜、医用耳脑胶等材料进行颅眶重建,术后重视颅内压管理并预防并发症发生。结果术后3 d,MRI检查示肿瘤全切除30例,次全切除3例,大部切除2例。无手术相关死亡发生。术后1周内发生脑脊液眼漏1例及术区感染2例,分别经腰大池持续引流10 d及抗生素治疗后治愈。患者均获随访,随访时间6～36个月,平均18个月。9例视力下降者术后1个月好转;眼眶胀痛者术后2周内明显缓解;眼球突出或眼位不正及眼球搏动等症状术后均消失。27例良性肿瘤患者24例痊愈,随访期间无复发;8例恶性肿瘤患者18个月内复发6例,行二次手术或放疗,其中2例于术后24个月死于肿瘤所致脑疝及呼吸循环衰竭。无眼球凹陷、搏动性突眼、颧部塌陷等并发症发生。结论采用自体骨片及钛网、额骨骨膜瓣、人工硬脑膜、医用耳脑胶等材料进行颅眶沟通性肿瘤切除后颅眶重建,具有稳固可靠、操作简便、易达解剖重建等特点,配合围手术期护理,可以取得较好手术效果。
Objective To summarize the methods of cranial orbital reconstruction during perioperative cranio-orbital tumor resection and its perioperative nursing experience. Methods From April 2008 to April 2011, 35 patients with cranial orbital tumor were treated. There were 21 males and 14 females, aged from 17 to 73 years (average 46.3 years). Orbital pain as the first symptom in 13 cases, 12 cases of decreased visual acuity, ocular protrusion or malposition in 5 cases, headache, dizziness in 2 cases, diplopia in 2 cases, 1 case of eyeball pulsation. Intraoperative resection of the lesion using autologous bone and titanium mesh, the frontal periosteal flap, artificial dura mater, medical ear glue and other materials for cranial orbital reconstruction, postoperative emphasis on intracranial pressure management and prevention of complications. Results Three days after operation, MRI showed 30 cases of total resection of tumor, 3 cases of subtotal resection and 2 cases of partial resection. No surgery-related death occurred. One case of cerebrospinal fluid leakage and 2 cases of intraoperative infection occurred within 1 week after operation. The patients were cured by continuous drainage of lumbar cistern for 10 days and antibiotic treatment respectively. All patients were followed up for 6 to 36 months with an average of 18 months. 9 cases of decreased visual acuity improved 1 month after surgery; orbital pain were significantly alleviated within 2 weeks after surgery; eyeball or eye position and eye movements and other symptoms disappear after surgery. Twenty-seven patients with benign tumors were cured and no recurrence was observed during the follow-up. Six patients with malignant tumors recurred within 18 months after surgery or radiotherapy. Two of them died of tumor-induced brain herniation 24 months after operation And respiratory failure. No eyeball depression, pulsating exophthalmos, zygomatic collapse and other complications occurred. CONCLUSION: The cranial orbital reconstruction after the cranio-orbital tumor resection with autologous bone fragments, titanium mesh, frontal periosteal flap, artificial dura mater, and medical ear glue has the characteristics of being stable and reliable, simple and easy to operate and anatomic reconstruction, With the perioperative care, you can get better surgical results.