内镜经鼻入路处理鼻咽癌放疗后颅底骨坏死临床体会  

The clinical experience of transnasal endoscopic approach for skull base osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma

作　　者：兰桂萍[1] 黄波[1] 司勇锋[1] 覃扬达[1] 邓卓霞 杨涌[1] 覃颖[1] 张本坚[1] 

机构地区：[1]广西壮族自治区人民医院耳鼻咽喉头颈肿瘤科,南宁530021

出　　处：《中华耳鼻咽喉头颈外科杂志》2016年第5期367-371,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：广西科学研究与技术开发计划项目（编号：桂科攻1355005-3-9）

摘　　要：目的 探讨内镜经鼻入路手术治疗鼻咽癌放疗后颅底骨坏死的可行性和临床疗效.方法 回顾性分析广西壮族自治区人民医院2008年至2013年收治的15例鼻咽癌放疗后颅底骨坏死患者的临床资料.15例患者的主要临床症状为头痛（数字评分法6～9分）11例次、鼻臭10例次,鼻出血4例次,听力下降5例次7耳,耳鸣4例次5耳.所有病例均采用全身麻醉下内镜经鼻入路手术治疗,术中充分暴露病变部位,切除坏死软组织,高速电钻磨除坏死骨质,术腔引流通畅;围手术期进行对症处理;记录术后恢复情况及随访结果.结果 15例患者术后病理证实均为坏死骨质及黏膜慢性炎,1例同时合并真菌性蝶窦炎.术后临床症状明显缓解,头痛消失9例,头痛减轻（评分3～5分）2例;鼻臭消失9例,减轻1例.术后随访18～82个月,中位随访时间31个月,13例患者存活,1例失访,1例患者死于高血压病脑出血.结论 采用内镜经鼻入路手术治疗鼻咽癌放疗后颅底骨坏死是安全、有效的方法,可提高患者生存率和生活质量.Objective To investigate the method of surgical treatment via trans-nasal endoscopic approach in osteoradionecrosis of skull base after radiotherapy for nasopharyngeal carcinoma.Methods Fifteen patients with osteoradionecrosis of skull base after radiotherapy for nasopharyngeal carcinoma who underwent operation via trans-nasal endoscopic approach from 2008 to 2013 were retrospectively reviewed.The typical clinical manifestations included headache （NRS 6-9：11 cases）,foul odor （10 cases）,epistaxis （4 cases）,hearing loss （5 cases,7 ears）,tinnitus （4 cases,5 ears）.All patients underwent operation via trans-nasal endoscopic approach.During the operation,the diseased region was fully exposed,the necrotic tissue was resected,the necrotic bone was removed by high-speed electric drill,and the drainage was made unobstructed.The perioperative treatment and follow-up were carried out.Results After operation,all patients were diagnosed pathologically as osteoradionecrosis and mucosal chroinic inflammation,1 case combined with fungal sphenoid sinusitis.Headache （9 cases） and foul odor （9 cases）resolved after operation.The follow-up was lasted 18-82 months,13 cases were survival,1 case lost to follow-up,1 case died of cerebral hemorrhage.Conclusion Surgical treatment via trans-nasal endoscopic approach is safe and effective in osteoradionecrosis of skull base after radiotherapy for nasopharyngeal carcinoma,and is helping to improve the survival rate and survival quality.

关 键 词：鼻咽肿瘤 癌 骨坏死 放射性 内窥镜检查 耳鼻喉外科手术 

分 类 号：R739.63[医药卫生—肿瘤]