摘要
目的探讨鼻内镜下手术治疗鼻咽癌放疗后诱发鼻咽颅底肉瘤的可行性,并分析其临床疗效。方法回顾性分析鼻内镜下手术治疗的鼻咽癌放疗后诱发鼻咽颅底肉瘤5例患者临床资料。结果 5例患者均于气管插管全麻下行经鼻内镜下鼻咽颅底肿瘤切除术,所有患者术后相关症状均有不同程度改善,未出现并发症。其中2例术后影像学检查示肿瘤残留,1例海绵窦区肿瘤残留者,术后3个月脑侵犯死亡;另外1例存活16个月后死于肿瘤复发压迫脑干呼吸衰竭。3例术后影像学检查未见肿瘤残留,其中1例拒绝放化疗,先后4次内镜手术,9个月后死于全身重要器官衰竭;1例术后行放化疗,20个月后死于颅内侵犯;另外1例行根治量放疗,存活20个月,最后因严重放射性脑病致无法进食,呼吸困难,全身重要器官衰竭死亡。结论鼻咽癌放疗后诱发肉瘤恶性程度高,预后差,如具备手术指征,应首选外科手术治疗,内镜手术联合术后放化疗有可能改善预后。
Objective To investigate the feasibility of endoscopic surgery for radiation-induced sarcoma （RIS） in patients with nasopharyngeal carcinoma （NPC） and to analyze its clinical efficacy. Methods A retrospective analysis was made on five NPC cases with RIS of nasopharynx and skull base. Results All five patients received nasal endoscopic surgery under general anesthesia. Their related symptoms were improved postoperatively with no severe complications. Postoperative imaging showed residual tumor in 2 cases： one patient whose residual tumor involved the cavernous sinus died of intracranial invasion within 3 months ; the other one died of respiratory failure due to brain stem compression 16 months after surgery. As for the 3 cases with negative postoperative imaging, one refusing chemoradiotherapy accepted endoscopic surgery successively for 4 times, and finally died of important organ failure 9 months after surgery. The other one case accepted postoperative radiotherapy and chemotherapy died of brain invasion, and the other patient who received two courses of radical radiotherapy finally died of multiple organ failure induced by radiation encephalopathy 20 months after oporation. Conclusions RIS is a rare tumor with high malignancy and poor prognosis. For the patients with operation indications, surgical treatment should be the preferred method. Endoscopic surgery combined with postoperative chemo-radiotherapy may improve the prognosis.
出处
《中国耳鼻咽喉颅底外科杂志》
CAS
2014年第1期11-16,共6页
Chinese Journal of Otorhinolaryngology-skull Base Surgery
关键词
鼻咽癌
放疗
肉瘤
鼻内镜术
Nasopharyngeal neoplasm
Radiotherapy
Radiation-induced sarcoma
Nasal endoscopic surgery
