鼻咽癌放疗后残留或复发不同rT分级的内镜挽救性手术特点分析  

Analysis of the characteristics of salvage endoscopic surgery for residual or recurrent nasopharyngeal carcinoma with different rT grading after radiotherapy

作　　者：粘家斌[1,2] 邱前辉[2] 

机构地区：[1]南方医科大学研究生院,广州510515 [2]广东省人民医院广东省医学科学院耳鼻咽喉-头颈外科

出　　处：《临床耳鼻咽喉头颈外科杂志》2016年第6期459-463,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的：了解鼻咽癌放疗后残留或复发不同rT分级的内镜挽救性手术的特点、处理方式,进而探讨不同内镜手术方式对疾病转归的影响。方法：回顾性分析因鼻咽癌放疗后残留或复发住院行鼻内镜挽救性手术的96例患者的临床资料。全部患者根据不同的rT分级均在全身麻醉下行相应的内镜下挽救性手术,合并颈部淋巴结残留或复发者在术中同期行根治性颈淋巴结清扫术。结果：96例患者中内镜下全部切除者44例（全切率45.8%）,次全切除者52例（次全切率54.2%）。术后随访至2015年4月,中位随访19个月（1~57个月）,共存活62例（64.6%）,死亡34例（35.4%）。患者1、2、3年累积生存率分别为83%、68%、63%,中位生存期为43个月。结论：鼻咽癌放疗后残留或复发的患者,内镜挽救性手术可获得较好的生存效果,不同的rT分级决定了内镜下切除肿瘤的方式不同,术中冷冻病理检查确定手术切缘的阴性率是保证手术疗效的关键。Objective：To understand the characteristics and the treatment methods of the Salvage endoscopic surgery for residual or recurrent nasopharyngeal carcinoma（rNPC）with different rT grading after irradiation failure,and to explore the effect of different endoscopic procedures on the prognosis of the diseases.Method：Ninetysix patients who underwent endoscopic salvage nasopharyngectomy for rNPC in our department between June 2009 and March 2015 were retrospectively reviewed.All the patients underwent the corresponding salvage endoscopic surgery under general anesthesia according to the different rT grading and the patients with cervical metastasis received the radical neck dissection at the same time.Result：The number of the patients whose lesions were completely removed was 44（Total removal rate 45.8%）,and the number of subtotal removal was 52（subtotal removal rate 45.8%）,respectively.Postoperative follow-up continued until April 2015,the median follow-up was 19months（1-57months）,the number of overall survival patients was 62（64.6%）,the number of death was 34（35.4%）.The overall 1year survival rate（SR）,2year SR,3year SR were 83%,68%,63%,respectively.The median survival time was 43 months.Conclusion：The patients who underwent salvage endoscopic surgery for rNPC could have a good survival rate,and the different rT grading made the different methods to resect the lesions by the endoscopy.The use of frozen pathological examination during the operation to determine the negative rate of the surgical margins is the key to ensure the operation curative effect.

关 键 词：鼻咽癌 残留或复发 内镜挽救性手术 

分 类 号：R739.6[医药卫生—肿瘤]