内镜下切除鼻咽部肿瘤入路及体会

摘要

目的 介绍内镜下经鼻中隔切除鼻咽部肿瘤的方法,探讨此手术方法的优缺点、适应范围和手术注意事项.方法 10例鼻咽部肿瘤患者分别为鼻咽癌放疗后残留3例、海绵状血管瘤2例、良性混合瘤2例、恶性混合瘤1例、腺样囊性癌1例和脊索瘤1例.所有病例均行内镜下鼻中隔后下段1/4切除,手术者和助手经双侧鼻腔径路协作完成肿瘤切除.结果 所有病例的鼻咽肿瘤均一次性全切,无严重手术并发症和后遗症.4例良性肿瘤随访6～18个月无复发,中位随访时间13.8个月;6例恶性肿瘤随访1～4年,中位随访时间2.6年,5例无瘤生存,1例鼻咽癌患者术后1年疑似复发,进一步观察6个月病变无进展.结论 鼻中隔后下段1/4切除后,内镜下能观察整个鼻咽腔及其中的肿瘤,并有利于手术者和助手协调配合完成手术,是一种切除鼻咽部局限性肿瘤较好的手术方法.%Objective To explre the techniques, advantages and disadvantages, indications and cautions of a surgical approach for the resection of nasopharyngeal tumor. Methods Ten cases with nasopharyngeal tumors were recruited in this study, of them, 3 cases with residual nasopharyngeal carcinoma after chemoradiotherapy, 2 cases with cavernous angioma, 2 cases with benign mixed tumor, 1 malignant mixed tumor, 1 adenoid cystic carcinoma, and 1 chordoma. All patients underwent endoscopic resection of posteroinferior quarter part of nasal septum, and then the removal of nasopharyngeal tumors through bilateral transnasal approach. Results Total resection of the tumor was achieved for all cases without severe surgical complications. All cases with benign tumors, with following-up of 6 -18 months, showed no recurrence. Of 6 cases with malignant tumors, with following-up of 12 -48 months, 5 cases showed no recurrence, and 1 case was suspected to relapse one year postoperatively, but not with any lesion enlargement after another 6 month follow-up. Conclusions Posteroinferior quarter part of nasal septectomy is preferred for endoscopic resection of nasopharyngeal tumors because it can provide a panoramic view on nasopharyngeal cavity and tumors, thus, facilitating the removal of nasopharyngeal tumors.