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目的 总结鼻腔鼻窦嗅神经母细胞瘤 (esthesioneuroblastoma,ENB)的临床经验。方法 对Fulda医院耳鼻咽喉 头颈及面部整形外科 1 988年 7月～ 2 0 0 1年 1 2月经治的 1 7例ENB的临床资料、手术治疗的径路、方法及预后进行回顾性分析。结果 据Morita等的临床分期标准 ,1 7例中A期1例 ,B期 6例 ,C期 9例 ,D期 1例。术后 8～ 1 63个月 (平均 44个月 )的随访观察结果表明 :2年既无复发、亦无转移的总生存率 90 90 % (1 0 / 1 1 ) ,其中A期为 1 / 1、B期为 6/ 6、C期为 3/ 3、D期为 0 / 1。所有经鼻内径路手术的 6例患者至今均存活 ,临床和影像学检查都无复发和转移迹象 ,存活最长者已达1 30个月 ;2例经额下径路手术的C期患者在随访的 8、2 7个月内均未发现复发和转移 ;经面正中掀翻径路手术的B、C期患者各 1例已分别存活 1 63个月和 82个月 ,均无复发和转移。 6例在此观察期间死于ENB :其中C期 5例、D期 1例 ;Ⅱ级 1例、Ⅲ级 1例、Ⅳ级 3例 (另 1例未行分级诊断 )。 1例 (C期/Ⅱ级 )于ENB术后 7年死于星形细胞瘤 ,此间一直无ENB复发。结论 联合应用手术和放射治疗ENB的效果最佳。前颅底恶性肿瘤的手术治疗径路选择应按照以下原则 :若病变组织没有浸润至颅内或眶内 ,采用鼻内径路 ;若肿瘤主要向侧向生长已
Objective To summarize the clinical experience of nasal sinus sinusitis (ESTB). Methods A retrospective analysis was performed on the clinical data, surgical approaches, and prognosis of 17 cases of ENB treated in Fulda Hospital between July 1998 and January 2011 in Department of Otorhinolaryngology Head and Neck Surgery and Facial Orthopedics. Results According to the clinical staging criteria of Morita et al., There were 1 case in stage A, 1 case in stage A, 6 cases in stage B, 9 cases in stage C and 1 case in stage D. The follow-up results of 8-163 months (mean 44 months) after operation showed that there was no recurrence at 2 years and the overall survival rate was 90 90% (1 0/1 1) without metastasis, in which stage A was 1 / 1, B 6/6, C 3/3, D 0/1. All of the 6 patients who underwent nasal route surgery survived so far. There were no signs of recurrence or metastasis in clinical and imaging studies, and the longest survival rate was 130 months. In the follow-up study, 2 patients with stage C undergoing frontal approach No recurrence and metastasis were seen within 8 and 27 months, respectively. One case of B and C patients who had undergone face-to-face median surgeries had survived for 1 63 months and 82 months respectively without recurrence and metastasis. Six patients died of ENB during this observation period. Among them, 5 were in stage C and 1 in stage D, 1 in stage Ⅱ, 1 in stage Ⅲ and 3 in stage Ⅳ. One patient (stage C / grade II) died of astrocytoma 7 years after ENB, and no ENB recurrence occurred. Conclusion The best combination of surgery and radiotherapy ENB is the best. Surgical treatment of anterior skull base tumor pathways should follow the following principles: If the lesion did not infiltrate into the intracranial or orbital, the use of nasal pathways; if the tumor to the lateral growth of