鼻腔筛窦鳞状细胞癌146例治疗分析

Objective To evaluate the treatment outcome of different therapeutic modalities for squamous cell cacinoma of the nose and ethmoid sinus and prognostic factors. Methods One hundred and forty-six cases of squamous cell carcinoma of the nose and ethmoid sinus treated from 1990 to 2007 were reviewed. Of the 146 cases,28 were at stage Ⅰ or Ⅱ ;46 stage Ⅲ ;72 stage Ⅳ. Forty-one patients were treated with preoperative radiation plus surgery( R + S) ,22 patients with surgery plus postoperative radiation ( S + R), 5 patients with surgery alone ( SA ), 78 patients with radiotherapy alone (RA). Results The overall 5 year survival rate of 146 patients with squamous cell carcinoma of the nose and ethmoid sinus was 49. 1%. The 5 year survival rate of the patients at stage Ⅰ and Ⅱ was 95. 7% ,while the rate was 59. 8% in the patients at stage Ⅲ and 28. 2% in the patients at stage Ⅳ ( x2 = 24. 15, P < 0. 05). The 5 year survival rate was 57.7% in R+S group,60.4% in S+R group, 100% in SA group,and 38.8% in RA group,respectively(P >0. 05). The 5 years survival rate of N + patients was lower than that of NO( x2 = 12. 326,P < 0. 05). Local recurrence and distant metastasis were main causes of death. Cox analysis showed TNM stage and differentiation of tumor were independent significant prognostic factors. Conclusions The higher survival rate of patients with squamous cell carcinoma of the nose and ethmoid sinus was obtained from combined therapy R + S or S + R. SA gave ideal results for early lesions(stage Ⅰ and Ⅱ ).     

鼻腔筛窦鳞状细胞癌146例治疗分析

Objective To evaluate the treatment outcome of different therapeutic modalities for squamous cell cacinoma of the nose and ethmoid sinus and prognostic factors. Methods One hundred and forty-six cases of squamous cell carcinoma of the nose and ethmoid sinus treated from 1990 to 2007 were reviewed. Of the 146 cases,28 were at stage Ⅰ or Ⅱ ;46 stage Ⅲ ;72 stage Ⅳ. Forty-one patients were treated with preoperative radiation plus surgery( R + S) ,22 patients with surgery plus postoperative radiation ( S + R), 5 patients with surgery alone ( SA ), 78 patients with radiotherapy alone (RA). Results The overall 5 year survival rate of 146 patients with squamous cell carcinoma of the nose and ethmoid sinus was 49. 1%. The 5 year survival rate of the patients at stage Ⅰ and Ⅱ was 95. 7% ,while the rate was 59. 8% in the patients at stage Ⅲ and 28. 2% in the patients at stage Ⅳ ( x2 = 24. 15, P < 0. 05). The 5 year survival rate was 57.7% in R+S group,60.4% in S+R group, 100% in SA group,and 38.8% in RA group,respectively(P >0. 05). The 5 years survival rate of N + patients was lower than that of NO( x2 = 12. 326,P < 0. 05). Local recurrence and distant metastasis were main causes of death. Cox analysis showed TNM stage and differentiation of tumor were independent significant prognostic factors. Conclusions The higher survival rate of patients with squamous cell carcinoma of the nose and ethmoid sinus was obtained from combined therapy R + S or S + R. SA gave ideal results for early lesions(stage Ⅰ and Ⅱ ).     

Transoral robotic nasopharyngectomy for local recurrent nasopharyngeal carcinoma北大核心CSCD

Objective To investigate the safety, efficacy, locally control and survival results of transoral Da Vinci robotic surgery for salvage treatment of locally recurrent nasopharyngeal carcinoma. Methods This retrospective study included 33 patients with locally recurrent nasopharyngeal carcinoma (stage rT1‑2, partial rT3) underwent transoral Da Vinci robotic surgery between October 2017 and January 2020. There were 20 males and 11 females, with an average age of (47.9±10.5) years. The lesions were localized in nasopharyngeal cavity in 14 cases, with extending to parapharyngeal space in 6 cases and the floor of sphenoid sinus in 13 cases. Transnasal endoscopy was used to assist surgery if necessary. SPSS 25.0 statistical software was used for statistical analysis. Results Transoral robotic nasopharyngectomy was successfully performed in all cases without conversion to open surgery, of which 13 cases were combined with transnasal endoscopic surgery. The average operation time was (126.2±30.0) min, ranging from 90 to 180 min. The postoperative pathological margin was R0 (31 cases) and R1 (2 cases), with no tumor residue. Complications of surgery mainly included symptoms of headache, nasal dryness and velopharyngeal insufficiency without nasopharyngeal hemorrhage. Follow‑up time was from 3 to 54 months. One case had tumor recurrence 11 months after operation, 1 case had ipsilateral cervical lymph node metastasis 27 months after operation, 2 cases had distant metastasis and 1 case died of nasopharyngeal hemorrhage 3 months after operation. The 1‑year, 2‑year and 3‑year overall survival rates were 97.0%, 96.0% and 92.9%, respectively and the local recurrence free rates were 97.0%, 95.7% and 91.7%, respectively. Conclusion Transoral robotic nasopharyngectomy is safe and feasible for local recurrent nasopharyngeal carcinoma in selected patients, with higher local control rate and quality of life. © 2022 Chin J Otorhinolaryngol Head Neck Surg. All rights reserved.     

Prognostic and proliferative evaluation of ameloblastoma based on radiographic boundary

Ameloblastoma is a benign odontogenic tumor with an aggressive biological behavior,and the surgical treatment frequently results in failure for the postoperative recurrence.The aim of this article was to investigate whether the proliferative ability and prognosis of ameloblastoma could be evaluated by the radiographic boundary.The ameloblastoma cases treated by the conservative therapy in our hospital between 1981 and 2001 were divided into three groups based on the nature of the radiographic borders of the lesions.The biologic behavior was evaluated by Ki-67 antibody immunohistochemically.Comparisons of prognosis and Ki-67 expression were carried out by statistic methods.There were 24 cases of well-defined edge with sclerosis(group I),41 cases of well-defined edge without sclerosis(group II) and 32 cases of ill-defined edge(group III).The recurrent rates were 29.2% in group I,43.9% in group II and 62.5% in group III(P,0.05).The cells in group III expressed the highest Ki-67 level(P,0.05).The radiographic boundary could be used as one of indicators in evaluating the proliferative ability of ameloblastoma and the patient’s prognosis,which was consistent with Ki-67 expression.     

未行喉切除术及放化疗治疗的喉癌患者生存分析

目的 探讨未接受喉切除术及放化疗治疗喉癌患者的生存率及其预后因素.方法 回顾性分析167例未行喉切除术及放化疗治疗喉癌患者的临床资料,应用Kaplan-Meier法计算生存率,单因素分析组间比较采用Log-rank检验,多因素分析采用Cox比例风险模型.结果 167例患者总的生存时间为(16.0±1. 4)个月(-x±s),1年、2年生存率分别为56.4%、26.5%;确诊超过5年的病例(除失访者外)尚无一例生存超过5年.单因素分析显示不同的肿瘤生长部位、病理分级、T分期、N分期对生存率的影响差异有统计学意义(P值均＜0.05).而行气管切开术的喉癌患者生存率与未行气管切开术者相比,差异无统计学意义(P＞0.05).多因素分析显示不同T分期、N分期对生存率的影响差异有统计学意义(危险比分别为1.812和1.557,P值均＜0.05).结论 喉癌病程发展较快,在未针对肿瘤本身治疗的情况下,姑息性手术如气管切开术并不能提高生存率.影响喉癌预后的因素为肿瘤生长部位、病理分级、T分期、N分期和临床分期,其中相对独立预后危险因素为T分期和N分期.

Abstract：

Objective To investigate the survival rate and prognostic factors of laryngeal carcinoma patients with no surgery,radiotherapy or chemotherapy.Methods One hundred and sixty-seven laryngeal carcinoma cases with no surgery,radiotherapy or chemotherapy were analyzed restrospectively.Survival rates were calculated by Kaplan-Meier product-limit method.With univariate analysis,comparisons among/between groups were performed using Log-rank test.Multivariate analysis was carried out using Cox proportional hazard model.Results Overall survival time was (16.0 ± 1.4) months (-x ± s),overall 1-and 2-year survival rates were 56.4％ and 26.5％,respectively.No patient survived over 5 years in these cases who had been diagnosed more than 5 years (except for those who lost).Univariate analysis showed that primary site,pathological grade,T-stage,N-stage and clinical stage were significant prognostic factors for the survival of the patients (P ＜ 0.05＝.The survival rates of laryngeal carcinoma whether with tracheotomy were no statistically significant (P＞0.05).Multivariate analysis showed survival rates statistically correlated with T stage and N stage (hazard ratio were 1.812 and 1.557,P ＜ 0.05).Conclusions The development of laryngeal carcinoma course was faster,without treatment to the tumor itself,even if palliative surgical such as tracheostomy would not improve the survival rate.In laryngeal carcinoma patients with no surgery,radiotherapy or chemotherapy,the factors affecting the survival rates include primary site,pathological grade,T-stage,N-stage and clinical stage,and of them,T-stage and Nstage are the independent prognostic factors.     

晚期鼻腔鼻窦恶性肿瘤的内镜外科治疗

目的 探讨晚期鼻腔鼻窦恶性肿瘤内镜下外科治疗的疗效.方法 回顾性分析2004年1月至2010年10月间解放军总医院收治的晚期的鼻腔鼻窦恶性肿瘤患者49例,按UICC6版标准分期,13期12例、T4a期13例、T4b期24例;病理类型为鳞癌20例,腺癌12例,恶性黑色素瘤8例,嗅神经母细胞瘤6例,横纹肌肉瘤、软骨肉瘤、神经胶质瘤各1例.所有患者均接受单纯鼻内镜手术或辅助鼻外入路根治手术,其中36例术后采用放化疗.随访数据采用Kaplan-Meier法生存分析.结果 术中出血200～5000 ml,平均约600 ml;术后未发生术腔(包括颅内)感染,经全量放疗未发生脑脊液鼻漏,失明1例.4例(8.2%)患者随访期内失访.随访期内30例复发转移,部分患者出现多处复发及转移,局部复发是治疗失败的主要原因,占复发病例的86.7%(26例).16例死亡患者中除3例外术前均有颅和(或)眼受累;嗅神经母细胞瘤及神经胶质瘤等其他病理类型组患者预后差,9例患者中随访期内5例患者死亡,其中3例伴颅内转移,目前生存时间尚无超过25个月者.2年和3年总体生存率分别为62.5%和58.4%,2年和3年无瘤生存率为34.2%和21.4%.Log-rank检验证实不同T分期、是否接受术后治疗以及切缘性质对患者无瘤生存率影响差异有统计学意义(x2值分别为7.7、6.8和4.9,P值均<0.05).结论 内镜经鼻或鼻外辅助路径下对晚期鼻腔鼻窦恶性肿瘤切除满意,结合术后综合治疗,患者生存率满意,并发症少,是鼻腔鼻窦晚期恶性肿瘤外科治疗的良好术式.

Abstract：

Objective To evaluate the effect of endoscopic surgery for advanced malignant tumors in the nasal cavity and paranasal sinuses. Methods A retrospective data analysis was performed on 49 patients with advanced sinonasal tumors undergoing either an exclusive endoscopic approach or with a complemental approach from January 2004 to October 2010. Forty-nine patients were considered eligible for editions of the UICC staging systems). The histotypes encountered were squamous cell carcinoma 20 cases,adenocarcinoma 12 cases, mucosal melanoma 8 cases, olfactory neuroblastoma 6 cases, others 3 cases.These patients were operated on either by an exclusive endoscopic endonasal approach or with a complementary external approach; 36 patients received adjuvant radiotherapy or/and chemotherapy. The data were analyzed by Kaplan-Meier method and Log-rank test. Results The hemorrhage varied from 200 to 5000 ml during the operation, with an average of 600 ml. The post-operative complications were rare,1 patient lost her sight after operation, and no patient got infected at the site of operation (nor intracranial infection). After full amount of radiotherapy, no cerebrospinal fluid rhinorrhea was found. Four patients ( 8. 2% ) lost to follow-up. Sixteen patients died during the follow-up period, only three of them were without craniocerebral or orbital invasion. Four in 9 patients in the other pathological group (with the pathology of olfactory neuroblastoma or glioma etc) , which had a poor prognosis, died during the follow-up period, of them, 3 had definitive evidence of intracranial metastasis, and none of the nine patients had been followedup beyond 25 months. The 2 and 3 year disease-free rates were 34. 2% and 21.4% , and overall survival rates were 62. 5% and 58. 4% respectively. The T stage, margin status, and whether accepted post operative adjuvant therapy were significant factors in predicting disease recurrence(x2 were 7.7, 4. 9, 6. 8 respectively and P <0.05). Conclusions Now the endoscopic techniques with or without complementary approaches is an effective way for complete tumor removal. With postoperative complementary therapy, it provides a satisfactory survival rate with few side effects and better quality of life.     

甲状腺髓样癌的外科治疗及预后分析

目的 探讨甲状腺髓样癌的临床特点及治疗方法,并对其预后及影响因素进行分析.方法 对1999年1月至2004年12月中国医学科学院肿瘤医院头颈外科收治的82例甲状腺髓样癌患者的临床资料进行回顾性分析.男性39例,女性43例;年龄16～77岁,中位年龄46岁.采用免疫组织化学方法,分别检测降钙素、嗜铬素、神经元烯醇化酶的表达水平,其中24例标本行降钙素水平检测.行患侧腺叶+峡部切除28例,甲状腺残叶切除24例,甲状腺全切除16例,单纯行颈清扫术及上纵隔淋巴清扫术14例.82例中行气管食管沟清扫68例;行单侧颈清扫53例,双侧颈清扫11例,经颈部上纵隔淋巴清扫13例,胸骨劈开上纵隔淋巴清扫5例.结果 所有病例均经病理证实为甲状腺髓样癌,免疫组织化学检查显示降钙素表达率最高,为95.8%,嗜铬素表达率为88.9%,神经元烯醇化酶表达率为80.0%.颈部淋巴转移率68.8%,Ⅱ区、Ⅲ区、Ⅳ区、Ⅴ区和Ⅵ区淋巴转移率分别为27.3%、47.7%、59.1%、11.4%和52.3%.总的5年生存率为87.8%,总的局部复发率为7.3%,对侧腺叶复发率为5.8%.单因素分析结果表明性别、年龄、TNM分期是影响预后的因素,多因素分析表明远处转移是影响预后的独立危险因素.结论 外科规范手术是甲状腺髓样癌治疗的主要方式;单侧散发型甲状腺髓样癌首次治疗时应行患侧腺叶+峡部切除,术后应密切随访,而对于双侧病灶或家族型者应行甲状腺全切除术.监测降钙素水平在甲状腺髓样癌预后有重要意义.

Abstract：

Objective To study the clinical characteristics, the surgical treatments and the prognostic factors of medullary thyroid carcinoma. Methods Eighty-two cases of medullary thyroid carcinoma undergoing surgeries between January 1999 and December 2004 were reviewed. There were 39 males and 43 females. Age ranged from 16 to 77 years old, with a median of 46 years old. The calcitonin, chronogranin A and neuron-specific enolase were analysed by immunohistochemistry in samples,and calcitonin was detected in 24 cases. Of them, 28 cases underwent lobectomy with isthmectomy, 24 for remained lobe dissection, 16 for total thyroidectomy, and 14 only for neck and upper mediastinal lymph node dissection. Of the 82 cases, 68 cases underwent trachea esophageal ditch dissection, 53 for unilateral neck dissection, 11 for bilateral neck dissection, 13 for upper mediastinal lymph node dissecion through transcervical approach, and 5 for mediastinal lymph node dissecion through inverted T-shaped incision. Results Immunohistochemical examination revealed that the expression rates of calcitonin, chronogranin A and neuron-specific enolase were 95.8%, 88.9% and 80. 0% respectively. Total metastasis rate of neck lymph nodes was 68.8%, and the rates in level Ⅱ, Ⅲ, Ⅳ, Ⅴ andⅥ were 27.3%, 47.7%, 59.1%, 11.4% and 52.3% respectively. The overall five-year survival rate was 87.8%. The recurrent rate of contralateral lobes was 5.8% and local recurrent rate was 7.3% respectively. Univariate analysis showed that gender, age and TNM stage were significant prognostic factors. Multivariate analysis revealed that distant metastasis was an independent prognostic factor. Conclusions Standard radical surgery of the primary and metastatic lesion is key to the treatment of medullary thyroid carcinoma. Lobectomy with isthmectomy should be applied to sporadic medullary thyroid carcinoma, with regular postoperative follow-up, and total thyroidectomy to familial or bilateral medullary thyroid carcinoma. Therefore. detecting the calcitonin is very imoortant for medullary thyroid carcinoma patients' prognosis.     

面中区恶性肿瘤80例手术缺损的修复

Objective To evaluate the reconstructive methods of outcome of midface defects following the removal of malignant neoplasms. Methods Eighty cases (54 males, and 26 females, age ranging from 23-79, with a median age of 53.5 years) ,of midface malignant tumors from 1997-2006 in Beijing Tongren Hospital were retrospectively reviewed. The clinical data including the type of midface region defects,reconstructive methods and the therapeutic outcome were analyzed. Of the 80 patients,6 cases were with type Ⅰ ( external nasal ) defect,56 with type Ⅱ (maxillary) defect, 14 with type Ⅲ (naso-facio-maxillary)defect and 4 with type Ⅳ ( maxillary defect combined with naso-facio-orbital cutaneous deficiency). Results The defects after the removal of malignant tumors were repaired with pedicle tissue flaps in 31 cases and free tissue flaps in 49 cases, respectively, one-stage reconstruction accounting for 73 cases (91.2%). KaplanMeier analysis showed total 3-year and 5-year survival rates were 63.8% and 40. 6%, respectively.Conclusions One-stage reconstruction is a satisfactory method for the repair of midface defect after the removal of malignant tumor, with good clinical outcome. Selection of repair methods should be based on defect types.     

面中区恶性肿瘤80例手术缺损的修复

Objective To evaluate the reconstructive methods of outcome of midface defects following the removal of malignant neoplasms. Methods Eighty cases (54 males, and 26 females, age ranging from 23-79, with a median age of 53.5 years) ,of midface malignant tumors from 1997-2006 in Beijing Tongren Hospital were retrospectively reviewed. The clinical data including the type of midface region defects,reconstructive methods and the therapeutic outcome were analyzed. Of the 80 patients,6 cases were with type Ⅰ ( external nasal ) defect,56 with type Ⅱ (maxillary) defect, 14 with type Ⅲ (naso-facio-maxillary)defect and 4 with type Ⅳ ( maxillary defect combined with naso-facio-orbital cutaneous deficiency). Results The defects after the removal of malignant tumors were repaired with pedicle tissue flaps in 31 cases and free tissue flaps in 49 cases, respectively, one-stage reconstruction accounting for 73 cases (91.2%). KaplanMeier analysis showed total 3-year and 5-year survival rates were 63.8% and 40. 6%, respectively.Conclusions One-stage reconstruction is a satisfactory method for the repair of midface defect after the removal of malignant tumor, with good clinical outcome. Selection of repair methods should be based on defect types.     

Different forms of free radial collateral artery perforator flaps for reconstruction after removal of oral tumors北大核心CSCD

Objective To investigate the efficacies of different forms of free radial collateral artery perforator flaps in repairing the defects after oral tumor surgeries. Methods From May 2016 to March 2021, 28 patients (22 males, 6 females, aged 35 ⁃ 62 years) with oral tumors admitted by Hunan Cancer Hospital received the reconstructive surgeries with the free radial collateral artery perforator flaps after removal of oral tumors, including 24 cases of tongue cancer (11 cases of tongue marginal cancer, 9 cases of tongue belly cancer and 4 cases of tongue cancer involved in the floor of the mouth) and 4 cases of buccal and oral cancer. Four forms of radial collateral artery perforator flaps were used: single perforator flaps for 6 cases, double perforators flaps for 7 cases, flaps without perforator visualization for 10 cases and chimeric perforator myocutaneous flaps for 5 cases. The recipient vessels were the superior thyroid artery and superior thyroid vein, and if second concomitant vein available, it was anastomosed with internal jugular vein in end‑to‑side fashion. SPSS 20.0 statistical software was used to analyze the data. Results The mean length of flaps was (9.7±0.4) cm, mean width (4.4±0.3) cm and mean thickness (1.1±0.4) cm. The mean length of the vascular pedicles was (7.1±0.6)cm (6.0-8.0 cm), the mean diameter of the radial accessory arteries was (1.1±0.3)mm (0.8-1.3 mm). Eleven cases(39.3%) had respectively one accompanying vein and 17 cases(60.7%) had respectively two accompanying veins, with the mean diameter of (1.1±0.3) mm (0.8-1.3 mm). All the 28 flaps survived, the donor and recipient wounds healed in one stage, the appearances of the flaps were satisfactory, only linear scars remained in the donor sites, and the upper arm functions were not significantly affected. Follow up for 12‑43 months showed that the flaps were soft with partially mucosalization, the reconstructed tongue and buccal cavity were in good shape, and the swallowing and language functions were satisfactory. The swallowing and language functions were retained to the greatest extent in 3 cases with near total tongue resection, although the functions were still significantly affected. There was no local recurrence of the tumor during follow‑up. One case had regional lymph node metastasis, and further lymph node dissection and comprehensive treatment were performed, with satisfactory outcomes. Conclusions The vascular pedicle of the radial collateral artery perforator flap has a constant anatomy, which can be prepared in different forms to improve the safety of the operation and minimize the donor site damage. It is an ideal choice for the repair of small and medium‑sized defects after oral tumor surgery. © 2023 Authors. All rights reserved.     

面中部横切口鼻锥体翻转进路在鼻咽癌复发挽救手术中的应用

目的探讨鼻咽癌复发挽救手术的途径。 方法4例鼻咽癌患者于1988年5月-1995年8月接受根治量放疗。治疗后2年-9年,出现局部复发。复发病灶累犯的部位:鼻咽部项壁、鼻腔、上颌窦、蝶窦、筛窦、鼻中隔和眼眶纸样板等部位。应用鼻侧切加横跨面中部切口鼻锥体翻转进路摘除肿瘤,术后给予60 Gy放疗。结果手术并发症少,4例患者生存满2年的1例,3年2例,5年1例。结论应用这一手术径路,术野暴露充分,可完整切除肿瘤。鼻咽癌复发挽救手术应用得当,部分病例仍可获得根治效果。     

鼻咽癌放疗后局部复发挽救性手术入路的探讨

目的探讨鼻咽癌放疗后鼻咽部复发挽救性手术入路的方法和效果。方法1998年1月—2003年1月对13例鼻咽癌放疗后鼻咽部复发进行挽救性手术治疗。手术采用经口腔硬腭入路2例，鼻锥内翻入路2例，上颌骨外旋入路5例，经颞下窝入路4例，术后随访2～5年。回顾性分析4种不同的手术路径与方法、适应证以及治疗效果。结果T1和T2a各2例患者经硬腭入路和鼻锥内翻入路，随访生存均达3年以上。3例T2b和2例13上颌骨外旋入路，分别在术后2个月、2年死亡，1例术后复发光敏治疗后带瘤生存13个月死亡；2例健在，随访分别达2年和4年。T44例经颞下窝入路，术后咬殆）功能均有影响，术后1年内死亡3例，1例随访2年健在。13例均无术中并发症，术后发生鼻咽部颅底骨坏死、脑脊液漏并发颅内感染、上消化道大出血各1例，2年生存率54％（7／13）。结论根据鼻咽复发肿瘤的部位、侵犯范围，以尽可能小的创伤获得足够的显露的原则选择手术入路。T1和他病变可外科手术根治，手术效果良好。肿瘤侵犯咽旁组织和中耳者，预后较差，手术可以减轻患者痛苦，延长生命。     

上颌骨翻转径路手术在鼻咽癌治疗中的应用

目的探讨上颌骨翻转径路手术在鼻咽癌治疗中的临床应用和价值。方法回顾性分析20例应用上颌骨翻转径路手术治疗的鼻咽癌患者,其中15例为放疗后复发（4例为再程放疗后）,3例为放疗后未控,2例为首诊行手术治疗。总结其临床病理资料、手术方法、治疗及随访结果。采用Kaplan-Meier法行生存分析,并绘制生存曲线。结果全组患者均手术顺利,肿瘤根治性切除,无术中并发症。术后2例患者出现明显的张口困难,5例出现腭瘘,1例出现分泌性中耳炎,1例出现上颌骨坏死行再次手术,另11例患者无明显术后并发症。术后随访4-80个月,3例出现局部复发,1例颈部复发,1例远处转移,11例患者无瘤生存,1例带瘤生存,8例死亡。总的中位生存期为35个月,2年累积生存率为66．1％。结论经上颔骨翻转径路切除鼻咽部肿瘤术野暴露良好,直视下可操作性强,手术切除彻底,是鼻咽癌手术径路的一种理想选择。     

喉部分切除术后复发癌的外科挽救治疗

目的 分析喉部分切除术后喉复发癌的外科治疗方法、预后及影响预后的因素.方法 回顾分析中国医学科学院肿瘤医院头颈外科77例喉部分切除患者术后喉复发癌再行外科挽救治疗的临床资料.其中51例行喉全切除术,26例行喉部分切除术,其中19例无放疗史者行手术加放疗的综合治疗.Kaplan-Meier法统计生存率,Cox多因素分析影...     

Comparison of survival rates of patients with nasopharyngeal carcinoma treated with radiotherapy, 5-fluorouracil and vitamin A ("FAR" therapy) vs FAR therapy plus adjunctive cisplatin and peplomycin chemotherapy

The overall survival rate (OSR) of 36 patients with nasopharyngeal carcinomas (NPC) treated at Kyushu University hospital between 1983 to 1992 was analyzed. As primary treatment, 16 patients received a combination therapy of 5-fluorouracil, vitamin A, and radiation (FAR therapy); two patients received radiotherapy only; 18 patients received FAR therapy plus adjunctive systemic chemotherapy consisting of cisplatin and peplomycin. The radiation dose to the nasopharynx was 6000 to 7050 cGy while that to the neck was 4000-6000 cGy. The 5-year OSR of all the patients was 49%. Histological type (moderately differentiated squamous cell carcinoma) and patient age (S 55) were found to be significant prognostic factors for a worse OSR. Although survival decreased with increasing T stage, no significant difference was observed. The 5-year OSR of the patients treated with FAR therapy was 53% and was 51% with FAR therapy plus chemotherapy. Compared to FAR therapy alone, adjunctive chemotherapy did not increase OSR of the patients with NPC.     

Nasopharyngectomy for recurrent nasopharyngeal carcinoma: a review of 53 patients and prognostic factors

CONCLUSIONS: Salvage surgery is a justified treatment for primary recurrence of nasopharyngeal carcinoma (NPC). Skull base surgery can play a role in rescuing patients with more advanced local recurrence of NPC. OBJECTIVES: The purpose of this study was to report the local control and overall survival outcome of patients with (NPC) with local failure who received salvage nasopharyngectomy and to identify prognostic factors. PATIENTS AND METHODS: Fifty-three consecutive patients who had primary recurrence of NPC and underwent salvage surgery with curative intention from July 1993 to December 2006 were retrospectively reviewed. The follow-up time ranged from 5.1 to 142.2 months. The numbers of cases of recurrent NPC stage were as follows: stage I, 26; stage II, 9; stage III, 10 and stage IV, 8. Fifty patients had one course of radiation therapy while 3 had two courses of radiation therapy before the salvage surgery. For the nasopharyngectomy, 2 patients underwent endoscopic approach and 33 underwent facial translocation, while 18 had craniofacial resection. Postoperative adjuvant treatment included radiation therapy, 4 cases; radiosurgery, 8 cases; concurrent chemoradiation therapy, 7 cases; and chemotherapy, 2 cases. RESULTS: The 5-year local control rates were T1, 58.3%; T2, 27.8%; T3, 53.3%; T4, 75.0%; and all stages, 53.6%. The 5-year overall survival rates were stage I, 64.8%; stage II, 38.1%; stage III, 25.9%; stage IV, 46.9%; and all stages, 48.7%. Multivariate analysis revealed that gender, margin status, adjuvant treatment type and parapharyngeal space involvement were significant impact factors of local control, whereas dura or brain involvement, local recurrence and adjuvant treatment type were significant impact factors of survival.     

颈颌腭入路－下颌骨外旋在鼻咽癌挽救性手术中的应用

目的探讨鼻咽癌放射治疗后复发肿瘤的挽救性手术方法.方法回顾性分析应用颈颌腭-下颌骨外旋入路,手术治疗鼻咽癌放射治疗未控患者2例、鼻咽部复发病变8例;二程放射治疗后病变复发2例,共1 2例（rT1 4例、rT2 7例、rT3 1例）患者的临床资料、手术方法及随访结果.结果 12例患者通过颈颌腭（下颌骨外旋）入路切除肿瘤,10例术中用带蒂颌下组织瓣Ⅰ期修复鼻咽部缺损;2例用游离下鼻甲修复鼻咽顶部缺损,7例患者无瘤生存、1例带瘤生存、3例患者死于局部复发、1例死于远处转移;患者2年总生存率为75%（9/12）.结论颈颌腭-下颌骨外旋入路切除鼻咽部肿瘤手术视野显露良好;可在直视下切除鼻咽及咽旁肿瘤处理颈内动脉,肿瘤切除后用带蒂颌下组织瓣Ⅰ期修复鼻咽部缺损手术及术后并发症少,是鼻咽癌放射治疗后复发肿瘤挽救性手术的一种理想的手术入路.     

鼻咽癌残留或复发外科挽救治疗的术式选择

目的 :探讨提高鼻咽癌放疗后残留或复发外科挽救治疗效果的手术方式。方法 :对经手术治疗鼻咽低分化鳞癌放疗后鼻咽部残留或复发患者 ,采取颈颌腭下颌骨翻转或上颌骨翻开及经口硬腭等手术入路切除复发病变 ;采用帽状腱膜瓣及胸大肌皮瓣进行术腔的修复和保护。结果 :手术并发症发生率为 16 % ,主要为局部感染或修复组织瓣坏死 ,术后后遗症较轻 ,腭鼻漏 4例 ,除 1例出现咬合错位外 ,其他病例功能及外观均得到满意的恢复。随诊达 3年以上 18例中死亡 8例 ,2例失访。结论 :根据复发肿瘤累及的部位及范围 ,选择最好的手术进路 ,争取相对彻底、安全地清除病变 ;同时采用方便可靠的修复办法 ,保护咽旁颅底重要结构 ,可以进一步提高手术治疗效果     

鼻咽癌放疗后颈淋巴结复发和残留的外科治疗

目的 分析鼻咽癌放疗后颈淋巴结残留和复发者的4种清扫方式的疗效，希望能为临床提供更多手术方式的选择。方法 回顾性分析88例鼻咽癌患者资料，分析总体疗效：生存率、复发率、远处转移率和手术并发症；比较全颈清扫、改良性、择区性颈清扫术和颈淋巴结切除术4种手术方式的生存率、复发率；比较术后颈部放疗与否者的生存率、复发率。结果 采用生命表法统计88例鼻咽癌患者5年累积生存率42.8％，颈淋巴结复发率为22．7％。Ⅱ期、Ⅲ期、Ⅳ期患者的5年生存率(生命表法)分别为56.7％、36．1％、32.4％。全颈清扫术、改良性颈清扫术、择区性颈清扫术和颈淋巴结切除术组5年累积生存率(Kaplan-Meier法)分别为39．8％、60．0％、37．9％和44．1％，差异无统计学意义(Log Rank统计值=1．0，P=0.8011)，颈淋巴结复发率差异也无统计学意义(χ^2=0．470，P=0．493)。颈清扫术后颈部给予与未给予术后放疗者的5年累积生存率(Kaplan-Meier法)分别为39．1％和45．3％，差异无统计学意义(Log Rank统计值=0．06，P=0．8138)，颈淋巴结复发率差异也无统计学意义(χ^2=0．593，P=0．441)。结论 只要合理选择病例，配合必要的术后局部和浅表的放疗，4种清扫方式都能有效和安全地控制肿瘤。     

胸大肌肌皮瓣在鼻咽癌放疗后颈部挽救性手术中的应用

目的总结胸大肌肌皮瓣在修复鼻咽癌放疗后颈部转移灶残留或复发根治术后缺损中的应用。方法回顾性分析27例鼻咽癌颈部转移灶残留或复发的病人,行根治性颈清扫术,对颈部皮肤缺损用胸大肌肌皮瓣修复。结果1例病人术后3 h死亡,26例病人均一期修复成功。1例术后发生乳糜漏,3例远端吻合口处有感染,5例肌皮瓣远端部分坏死,8例延迟愈合。3年生存率为52.4%。结论鼻咽癌放疗后颈部转移灶残留或复发的挽救性手术应选择根治性颈清扫术;胸大肌肌皮瓣血供丰富,易成活,可取瓣面积大,能满足修复术后缺损的需要。