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目的分析T3T4期鼻腔鼻窦鳞癌的治疗与预后。方法对2006年1月~2010年12月在湖南省肿瘤医院头颈外科手术治疗的65例T3T4鼻腔鼻窦鳞状细胞癌初治患者的临床资料进行单因素和多因素分析。其中鼻侧切开联合冠状开颅行上颌骨全切20例,患侧颌下切口裂开下唇行上颌骨全切27例,上颌骨+面部皮肤及软组织切除10例,上颌骨切除+眶内容剜除术8例;颈淋巴清扫术35例;游离股前外侧皮瓣修复硬腭和上颌骨缺损35例。单纯手术13例,术前放疗+手术20例,手术+术后放疗32例。结果本组所有患者中局部复发16例,局部复发伴远处转移11例,远处转移9例。死于局部复发22例,颈部转移5例,远处转移8例。单因素分析表明肿瘤T分级、N分级及是否辅助放疗与患者5年生存率具有相关性(P<0.05),多因素分析表明肿瘤T分级、N分级及是否辅助放疗是影响患者术后5年生存率的独立因素(P<0.05)。所有患者3、5年生存率分别为42.07%、32.28%。术前放疗+手术者3、5年生存率分别为43.62%、31.41%,手术+术后放疗者3、5年生存率分别为42.52%、33.36%,手术前后放疗两组比较差异无统计学意义(P>0.05);单纯手术者疗效极差,1年生存率58.4%,2年生存率为0。结论辅助放疗是提高晚期鼻腔鼻窦鳞癌生存率的重要手段;肿瘤T分级、有无淋巴结转移及是否辅助放疗是影响患者预后的相关因素和独立因素。
Objective To analyze the treatment and prognosis of T3T4 stage nasal sinus cancer. Methods From January 2006 to December 2010 in the Cancer Hospital of Hunan Province surgical treatment of 65 cases of T3T4 nasal sinus squamous cell carcinoma of the initial clinical data were analyzed by univariate and multivariate analysis. Incision of the nasal side combined with cranial craniotomy 20 cases of total maxillary resection, the ipsilateral submaxillary incision in the lower lip split maxillary resection in 27 cases, maxillary + facial skin and soft tissue resection in 10 cases, maxillary resection + orbital Content excision in 8 cases; neck lymph dissection in 35 cases; free anterolateral skin flap repair hard palate and maxillary defects in 35 cases. Simple surgery in 13 cases, preoperative radiotherapy + surgery in 20 cases, surgery + postoperative radiotherapy in 32 cases. Results All patients in this group of local recurrence in 16 cases, local recurrence with distant metastasis in 11 cases, distant metastasis in 9 cases. 22 died of local recurrence, 5 cases of cervical metastasis, distant metastasis in 8 cases. Univariate analysis showed that there was a correlation between T grade, N grade and adjuvant radiotherapy and 5-year survival rate of patients (P <0.05). Multivariate analysis showed that tumor T grade, N grade and whether adjuvant radiotherapy affect the patients 5 years after operation Independent factors of survival rate (P <0.05). The 3-year and 5-year survival rates of all patients were 42.07% and 32.28%, respectively. The 3- and 5-year survival rates of preoperative radiotherapy + surgery were 43.62% and 31.41%, respectively. The 3 and 5-year survival rates of surgery and postoperative radiotherapy were 42.52% and 33.36% respectively. There was no significant difference between the two groups before and after radiotherapy Significance (P> 0.05); simple surgery were very poor efficacy, 1-year survival rate of 58.4%, 2-year survival rate of 0. Conclusion Adjuvant radiotherapy is an important means to improve the survival rate of advanced nasal sinus squamous cell carcinoma. T grade, lymph node metastasis and adjuvant radiotherapy are the related factors and independent factors affecting the prognosis of patients.