鼻咽癌放疗后未控患者挽救性手术治疗  

Clinical outcomes of salvage surgery for nasopharyngeal carcinoma after irradiation failure

作　　者：张宗敏[1] 徐震纲[1] 刘绍严[1] 王晓雷[1] 吴跃煌[1] 祁永发[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院肿瘤研究所头颈外科,100021

出　　处：《中华耳鼻咽喉头颈外科杂志》2012年第6期462-465,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨鼻咽癌放疗后未控患者挽救性治疗方案，分析手术的治疗效果。方法回顾性分析1993--2009年治疗的鼻咽癌放疗后原发部位局部未控或复发挽救性手术患者84例。病理：鳞癌75例，黏液表皮样癌3例，腺样囊性癌2例，腺鳞癌2例，肌上皮癌1例，未分化癌1例。复发T分级rT1级34例，rT2级27例，rT3级12例，rT4级11例。84例患者中rN0级70例，rN1级9例，rN2级5例。鼻咽部术式：上颌骨外翻进入47例，下颌骨升支切除入路15例，下颌骨裂开入路6例，鼻侧壁切开入路7例，硬腭入路6例，上颌骨切除3例。结果手术切除较彻底57例（67．9％），手术切除不满意27例（32．1％）。鼻咽癌合并颈转移14例。总5年生存率43．6％。中位随访27个月。单因素分析显示患者rTNM分期、11r分级、手术是否切除干净、放疗疗程对比、是否合并淋巴转移与患者的预后有关（均P〈0．01），而病理分化程度与患者预后无关（P〉0．05）。Cox多因素回归分析显示是否合并颈转移、是否切除干净是独立的预后影响因素。术后发生局部再复发的病例为35例，远处转移5例，5年随访期内36例死亡，以复发为主要死因。结论鼻咽癌放疗后未控，手术挽救可以获得较好的生存效果。Objective To study salvage surgery for persistent or recurrent nasopharyngeal carcinoma after irradiation failure. Methods A total of 84 cases underwent salvage surgery for persistent or recurrent nasopharyngeal carcinoma after irradiation failure between 1993 and 2009 was reviewed, rTNM stage： rTl 34 cases,rT2 27 cases, rT3 12 cases and rT4 11 cases; rN0 70 eases, rN1 9 eases and rN2 5 cases;No with distance metastatis. The salvage surgeries were performed using maxillary swing approach （4-7 cases ） , transcervieo-mandibulo-palatal approach （ 21 cases ） , palate nasopharyngectomy （ 6 cases ） , lateral rhinotomy （7 eases ）, and maxillectomy （3 eases ）. Results Persistent or recurrent nasooharvn^ealcarcinoma after irradiation failure was resected completely in 57 patients （67.9%）and there were microscopic residual siseases in 27 patients（32.1% ）. The median follow-up was 27 months. Postoperative recurrence occurred in 35 cases, Thirty-six patients died of recurrence, metastasis and other diseases. The overall 5 year survival rate was 43.6%. Cox regression analysis indicated the complete resection for persistent or recurrent disease and no cervical metastasis were two independent factors affecting survival. Conclusions Salvage surgery for persistent or recurrent nasopharyngeal carcinoma after irradiation failure is an effective treatment.

关 键 词：鼻咽肿瘤 肿瘤复发 局部 放射疗法 预后 

分 类 号：R739.63[医药卫生—肿瘤]