内镜下或内镜联合下的鼻腔鼻窦恶性肿瘤手术的体会

摘要

目的 探讨内镜下或内镜联合鼻腔鼻窦恶性肿瘤的可行性和临床价值.方法 对我院耳鼻喉科收治的经内镜下或内镜联合手术治疗鼻腔鼻窦恶性肿瘤60例患者进行回顾性分析,随访57例,失访3例,失访人员作死亡病例,按UICC6版标准分期,T1-2期25例、T3期11例、T4a期12例、T4b期12例,病理类型为上皮源性、间叶组织,黑色素细胞及涎腺组织等,所有患者均接受内镜下或内镜联合手术,46例术后采用放化疗,60例患者随访数据采用SPSS18.0的Kaplan—Meier法生存分析.结果 所有病例随访2~8年,16例随访5年以上,2年、3年和5年总体生存率分别为63.3%、38.3%和13.3%,2年、3年和5年无瘤生存率为48.3%、35.0%和13.3%.3例术中发生脑脊液鼻漏,分别采用鼻中隔粘膜瓣和鼻甲粘膜瓣给予修补,均成功.随访期内28例死亡,局部复发15例,8例选择再次手术,1例因为自身情况选择放化疗,目前4例带瘤生存.2例颈部淋巴结转移,10例远处扩散,2例颅内转移.结论 内镜下或内镜联合可以彻底切除经过选择的鼻腔-鼻窦恶性肿瘤,优点是创伤小,避免或减轻颜面部瘢痕,术后并发症少,结合术后放化疗,提高了患者的生存质量,临床应用价值较高.%Objective To investigate the feasibility and clinical value of endoscopic surgery or endoscopic-combined surgery for sinonasal malignacy. Methods Sixty cases of patients with sinonasal malignacy treated by endoscopic surgery or endoscopic-combined surgery in our hospital ENT were retrospectively analyzed. Among them, fifty-seven cases were followed up while three cases were lost, and regarding them as death. T1~2:T3:T4a:T4b were 25:11:12:12 (T stage was assessed with the sixth editions of the UICC staging systems). The main pathological types included the epithelial and mesenchymal tissues, melanin cell and salivary gland tissue, etc. All patients were operated either by an exclusive endoscopic endonasal approach or endoscopic surgery complementary external approach. Forty-six patients received radiotherapy and/or chemotherapy. The date was analyzed by SPSS18 Kaplan-Meier method. Results All the patients were followed up for a period two to eight years after operation while sixteen cases survived for more than five years. The ovreall survival rates of 2 year, 3 year and 5 year were 63.3%, 38.3% and 13.3% while the disease-free survival rates were 48.3%, 35.0% and 13.3%. Cerebrospinal fluid (CSF) rhinorrhea occurred in three cases in the operation, using the nasal septum mucosa flap and turbinate mucosa flap respectively to repair the fistulae which were successful. Twenty-eight cases died during the follow-up period, fifteen cases occured local recurrence. Among them, eight cases received revision twice endoscopic sinus surgery, one accepted radiotherapy and chemotherapy because of her poor body. Four cases were survival with tumor at present. Two cases occured cervical lymph node metastases, ten cases of distant spread, and two cases of intracranial metastases. Conclusion Sinonasal malignacy after filtrated could be removed completely through endoscopic surgery with or without endoscopic-combined surgery. The advantages are little trauma, avoiding or reducing facial scar, few side effects. Combined with postoperative radiotherapy and chemotherapy, the survival quality and clinical application value have improved.