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背景与目的:对于放疗后鼻咽局限性残留、复发鼻咽癌,二程放疗可以使部分患者得到长期局部控制,但其放射性后遗症也相当严重;而救援性外科手术在取得相仿甚至更优疗效的同时,避免了这些放射性后遗症。然而,传统开放式手术进路创伤大,术野欠清晰,难以按肿瘤外科原则进行连续、整块切除。本研究旨在探索一种新的微创性鼻内镜进路的复发鼻咽癌外科治疗方法。方法:从2004年9月至2007年1月,25例放疗后鼻咽局限性残留或复发鼻咽癌患者在中山大学肿瘤防治中心进行经鼻内镜鼻咽切除术,将鼻咽肿瘤和足够的安全边缘连续、整块切除。观察其疗效和并发症。结果:25例患者均在鼻内镜进路下按肿瘤外科手术原则进行根治性整块切除,仅1例切缘阳性,鼻咽创面愈合良好,均未追加术后放疗。中位随访时间13个月(3～31个月),1例原位残留,3例术后原位复发,无远处转移和死亡。1年总生存率100%,无局部复发生存率达86.0%。无张口、吞咽、发音困难和其他手术并发症发生,无围手术期死亡。结论:鼻内镜进路鼻咽癌救援手术能充分暴露鼻咽以及咽旁间隙浅部,能将鼻咽残留、复发病灶按肿瘤外科原则进行连续、整块根治性切除,并发症少而轻,近期疗效满意。
BACKGROUND & OBJECTIVE: In the long-term local control of nasopharyngeal carcinoma and recurrent nasopharyngeal carcinoma after radiotherapy, the long-term local control of some nasopharyngeal carcinoma patients, but its radioactive sequelae are also quite serious; and rescue surgery in obtaining similar or even better efficacy At the same time, these radioactive sequelae are avoided. However, traditional open surgical approach trauma, surgical field is not clear, it is difficult to follow the principle of tumor surgery for continuous, monolithic resection. This study aimed to explore a new minimally invasive endoscopic approach to surgical treatment of recurrent nasopharyngeal carcinoma. Methods: From September 2004 to January 2007, 25 patients with nasopharyngeal residual or recurrent nasopharyngeal carcinoma after radiotherapy were treated with endoscopic nasopharyngectomy at Sun Yat-sen University Cancer Center. The safety margin is continuous, the whole block is removed. Observe its efficacy and complications. Results: Twenty - five patients underwent radical resection of the tumor under endoscopic sinus surgery. Only one patient with a positive margins and a good healing of nasopharyngeal wounds did not receive postoperative radiotherapy. The median follow-up time was 13 months (range, 3 to 31 months). One patient was left in situ and three patients were treated with orthotopic recurrence. There was no distant metastasis or death. 1 year overall survival rate of 100%, no local recurrence survival rate of 86.0%. No mouth opening, swallowing, dysarthria and other complications occurred, no perioperative deaths. Conclusion: Endoscopic nasopharyngeal carcinoma rescue operation can fully expose the nasopharynx and the parapharyngeal space shallow, nasopharyngeal residual and recurrent lesions according to the principle of tumor surgery for continuous, the whole block radical resection, less complications and less complications The recent effect is satisfactory.