摘要:
目的:分析经鼻内镜手术治疗侵及眼眶的鼻腔鼻窦恶性肿瘤的疗效,并探讨影响其预后的相关因素.方法:回顾性收集2010年1月至2017年12月四川省人民医院耳鼻咽喉头颈外科收治的36例侵及眼眶的鼻腔鼻窦恶性肿瘤患者的临床资料,随访其5年生存率和复发率及并发症等情况,并探讨影响患者预后的相关危险因素.结果: 36例术后患者,2例失访,随访完成率94. 4% ;34例患者随访时间为8~76个月,中位随访时间26个月,平均随访(27. 2 ± 18. 6)个月;随访期间肿瘤复发13 例,复发率36. 1% ;患者术后1 年、3 年、5 年生存率( OS)分别为86. 1% 、75. 0% 、52. 8% .不同临床分期患者总体中位生存期(OS)分别为:1期60个月、2期为20个月、3期为16个月,生存曲线之间差异有统计学意义(χ2 =4. 252; P=0. 039);不同病理类型患者总体中位生存期(OS)分别为:鳞状细胞癌19个月、腺样囊性癌36个月、肉瘤11个月、其它恶性肿瘤49个月,生存曲线之间差异尚未显示有统计学意义(χ2 =3. 736; P=0. 291).多因素Cox回归分析显示,临床分期是影响患者预后的独立危险因素(P<0. 05).结论:鼻内镜下手术治疗侵及眼眶的鼻腔鼻窦恶性肿瘤疗效确切,患者的预后与临床分期密切相关.%Objective: To analyze the effect of endoscopic transnasal surgery in the treatment of nasal cavity and paranasal sinus malignant tumors involving orbit, and explore the related factors affecting the prognosis. Methods: Clinical data of 36 cases of nasal cavity and paranasal sinus malignant tumors in-volving orbit who underwent surgical treatment in Sichuan Pro-vincial People’s Hospital between January 2010 and Decem- ber 2017 were reviewed retrospectively. The 5-year survival rate, recurrence rate and complications were followed up, and the related risk factors affecting the prognosis of the patients were discussed. Results: In this group of 36 patients, 2 patients were lost, and the follow-up completion rate was 94. 4% ; 34 patients were followed up for 8 to 76 months, with a median fol-low-up of 26 months, and a mean follow-up of (27. 2 ± 18. 6) months; follow-up was conducted among 13 cases during the period of tumor recurrence, and the recurrence rate was 36. 1% . The 1-year, 3-year, and 5-year overall survival (OS) were 86. 1% , 75. 0% , and 52. 8% , respectively. The median OS of phase Ⅰ~Ⅲ patients were 60 months, 20 months and 16 months, respectively. There was statistically significant difference in the survival curves among patients with clinically differ-ent stages (χ2 =4. 252, P=0. 039). The median OS of squamous cell carcinoma patients, adenoid cystic carcinoma pa-tients, sarcoma patients and other malignant tumor patients were 19, 36, 11 and 49 months. The difference in survival curves among patients with different pathological types was not statistically significant (χ2 =3. 736; P=0. 291). Multivariate Cox regression analysis showed that clinical stage was an independent risk factor affecting patients’ outcomes (P<0. 05). Conclusion: Endoscopic transnasal surgery for nasal cavity and paranasal sinus malignant tumors involving orbit is effective. The prognosis of patients is closely related to clinical stage.