摘要
目的探讨鼻咽癌放疗后鼻咽部复发挽救性手术入路的方法和效果。方法1998年1月—2003年1月对13例鼻咽癌放疗后鼻咽部复发进行挽救性手术治疗。手术采用经口腔硬腭入路2例,鼻锥内翻入路2例,上颌骨外旋入路5例,经颞下窝入路4例,术后随访2～5年。回顾性分析4种不同的手术路径与方法、适应证以及治疗效果。结果T1和T2a各2例患者经硬腭入路和鼻锥内翻入路,随访生存均达3年以上。3例T2b和2例T3上颌骨外旋入路,分别在术后2个月、2年死亡,1例术后复发光敏治疗后带瘤生存13个月死亡;2例健在,随访分别达2年和4年。T44例经颞下窝入路,术后咬)功能均有影响,术后1年内死亡3例,1例随访2年健在。13例均无术中并发症,术后发生鼻咽部颅底骨坏死、脑脊液漏并发颅内感染、上消化道大出血各1例,2年生存率54%(7/13)。结论根据鼻咽复发肿瘤的部位、侵犯范围,以尽可能小的创伤获得足够的显露的原则选择手术入路。T1和T2病变可外科手术根治,手术效果良好。肿瘤侵犯咽旁组织和中耳者,预后较差,手术可以减轻患者痛苦,延长生命。
Objective To evaluate salvage surgical approaches and efficacy for post-radiation local recurrent nasopharyngeal carcinoma （NPC）. Methods Thirteen patients with post-radiation local recurrent NPC underwent salvage surgical treatment by routes as transpalatal approach,nasal medial swing approach, maxillary swing approach and infratemporal fossa approach. All cases were followed up for 2 to 5 years. Analysis was done on the indications and efficacy of these 4 different approaching routes. Results No immediate operative complications occurred for all these 13 cases. Four patients with TI and T2a operated via transpalatal approach and nasal medial swing approach survived more than 3 years. Five patients with T2b and T3 operated via maxillary swing approach. Among them, two patients died at second and 24th month after operation, one survived with tumorand died at 13rd month after operation, two were alive free of tumor for 2 and 4 years after operation. Four patients with T4 operated via infratemporal fossa approach. Among them, three died in 1 year, one was alive free of tumor for 2 years. Conclusions Surgical approaches were decided by a comprehensive consideration of recurrent tumor site and invasive range to achieve the best operative site exposure with minimal traumatic damage.
出处
《中华耳鼻咽喉头颈外科杂志》
CAS
CSCD
北大核心
2005年第11期810-813,共4页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
关键词
鼻咽肿瘤
肿瘤复发
局部
外科手术
Nasopharyngeal neoplasms
Neoplasm recurrence, local
Surgical procedures,operative
