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.

Transcervico-mandibulo-palatal approach in salvage surgery of nasopharyngeal carcinoma

OBJECTIVE To explore the surgical approach for recurrent or residual nasopharyngeal carcinoma after radiotherapy failure. METHODS The clinical data of 12 patients with recurrent or residualnasopharyngeal carcinoma after radiotherapy failure for salvage surgery were retrospectively analyzed. The 12 patients were underwent salvage surgery via transcervico-mandibulo-palatal approach. The residual and recurrent tumors were found in 2 and 10 patients (included 2 recurrent patients after re- radiation) after radiotherapy respectively. RESULTS The paranasopharyngeal region defects were repaired with submandibular gland flaps in 10 patients and with free inferior turbinate mucosal graft in 2 patients. All of the 12 patients were followed up for more than 2 years. Seven patients survived with no evidence of disease and one patient survived with tumor. Three patients died of local recurrence and one died of distant metastasis. The 2-year survival rate was 75 %. CONCLUSION Resection of the local recurrent nasopharyngeal carcinoma via transcervico- mandibulo-palatal approach provides wide field exposure of the central skull base. The tumors located in paranasopharyngeal region can be resected en bloc and the internal carotid artery can be identified by palpation under direct vision. The surgical defects can be repaired with submandibular gland flap. The transcervico-mandibulo-palatal approach is the suitable procedure for local recurrent nasopharyngeal carcinoma with less mortality and complications.