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目的探索上颌窦晚期恶性肿瘤手术治疗最佳方案。方法对30例病人进行前瞻性分组研究:根治性手术组14例,其中行根治性上颌骨切除术10例、上颌骨切除合并眶内容物摘除术4例;功能保全性手术组16例,均行功能保全性上颌骨切除术。两组病例术前均行辅助性短程化疗,术后均行放射治疗。病人出院前及术后半年以上随访期间,分别应用直接和间接收集法了解病人的心理变化。结果根治性手术组术后2,3,5年生存率依次为64.3％(9/14),50.0％(6/12),45.5％(5/11);功能保全性手术组术后2,3,5年生存率依次为75.0％(12/16),60.0％(9/15),53.8％(7/13)。功能保全性手术组的2,3,5年生存率均高于根治性手术组。但两者间差异无统计学意义(P=1.00)。根治性手术组病人心理反应评价为积极型3例、消极型11例;而功能保全性手术组病人心理反应为积极型12例、消极型4例。与根治性手术比较,功能保全性上颌骨切除术对病人的心理反应有积极影响。结论功能保全性上颌骨切除术可作为晚期上颌窦恶性肿瘤的首选治疗方案。
Objective To explore the best surgical treatment of advanced maxillary sinus surgery. Methods Thirty patients were prospectively divided into groups: radical surgery group (14 cases), radical mastectomy (10 cases), maxillary excision combined with orbital content excision (4 cases), functional preservation group (16 cases) Line function preserving maxillary resection. Two groups of patients underwent preoperative adjuvant short-course chemotherapy, postoperative radiotherapy. During the follow-up period of more than half a year before and after the patients were discharged, the patients were directly or indirectly collected to observe the psychological changes. Results The survival rates at 2, 3 and 5 months after operation in the radical operation group were 64.3% (9/14), 50.0% (6/12) and 45.5% (5/11) The 3-and 5-year survival rates were 75.0% (12/16), 60.0% (9/15) and 53.8% (7/13), respectively. The 2, 3, 5-year survival rates in functional preservation group were significantly higher than those in radical surgery group. However, there was no significant difference between them (P = 1.00). In the radical surgery group, the patients’ psychological reactions were evaluated as positive type in 3 cases and negative type in 11 cases. In the functional preservation group, the psychological reaction was positive in 12 cases and negative in 4 cases. Functional preservation maxillary resection has a positive effect on the patient’s psychological response compared with radical surgery. Conclusions Functional preservation maxillary resection can be the first choice of treatment for advanced maxillary sinus malignancies.