31例局部复发鼻咽癌的鼻内镜手术治疗及预后影响因素分析  

Endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma:a review of 31 pafients and analysis of the prognostic factors

作　　者：毛晓春[1] 项洋锋[1] 姜琳[1] 聂喜林[1] 郑传铭[1] Mao Xiaochun;Xiang Yangfeng;Jiang Lin;Nie Xilin;Zheng Chuan-ming(Department of Head and Neck Surgry,Zhejiang Cancer Hospital,Hangzhou 310000,China)

机构地区：[1]浙江省肿瘤医院头颈肿瘤外科,杭州310000

出　　处：《中国医师杂志》2018年第8期1159-1163,共5页Journal of Chinese Physician

基　　金：浙江省自然科学基金项目(LY17H280003);浙江省医药卫生科技计划项目(2014KYB045)~~

摘　　要：目的探讨鼻内镜手术在局部复发性鼻咽癌治疗中的作用,分析临床效果及判断预后。方法回顾性分析2010年9月至2016年10月于浙江省肿瘤医院行鼻内镜下手术切除的31例复发性鼻咽癌患者的资料。记录分析患者性别、年龄、T分期、病理类型、复发部位、手术时间、手术出血量、围手术期并发症、术后复发时间及部位、生存情况等临床病理特征,观察疗效并分析预后。结果所有患者均成功接受内镜下鼻咽癌局部复发灶切除术,无一例行鼻外进路手术,手术时间45～180(108.55±34.36)min,手术出血量5～50(23.05±16.11)ml。无严重术中、术后并发症,无手术死亡病例,1例切缘阳性。术后随访时间3～82(36.48±21.79)个月。随访期间,29例存活,其中9例带瘤生存,1例并发口咽癌,1例失访,1例死亡。术后6例局部复发、1例肝转移、2例颈部淋巴结转移。2例术后复发患者接收再次鼻内镜下手术,术后随访至今无复发。术后1年总生存率、无病生存率及无局部复发生存率分别为96.67%、80.00%和86.67%,术后5年无病生存率61.80%。局部无进展生存时间2～82(31.87±23.26)个月。多因素分析提示年龄、性别、初始T分期、肿瘤坏死均不是影响患者生存的独立预后因素。结论鼻内镜进路行鼻咽癌局部复发的挽救性手术能充分暴露鼻咽部,手术并发症少,术后患者满意度较高,效果良好。鼻内镜手术是局部复发性鼻咽癌安全有效的治疗方法之一,值得临床推广。ObjectiveTo evaluate the efficacy of endoscopic nasopharyngectomy in the management of recurrent nasopharyngeal cancers （NPC）and to identify the prognostic factors.MethodsBetween september 2010 and october 2016, 31 patients who received endoscopic nasopharyngectomy in our hospital for recurrent NPC were retrospectively reviewed. The clinical and pathological features of the patients, such as sex, age, T stage, pathological type, recurrence location, operation time, bleeding volume, perioperative complications, postoperative recurrence time, location and survival were recorded and analyzed, and the prognosis was observed.ResultsAll patients underwent endoscopic resection of nasopharyngeal carcinoma locally, and no 1 cases received external nasal route surgery. All patients underwent successful endoscopic nasopharyngectomy.No patient was transferred to open approach.The mean operative time was （108.55±34.36）min. The average blood loss was （23.05±16.11）ml. No serious postoperative complications occurred. no surgical deaths, and 1 cases had positive edge. Postoperative follow-up time was 3-82 months. During follow-up, 29 cases survired, including that 9 patients survived with disease, 1 patient concurrent oropharyngeal carcinoma, 1 patient lost and 1 patient died. There were 6 cases of local recurrence, 1 cases of liver metastasis and 2 cases of cervical lymph node metastasis after operation, 2 patients with recurrent postoperative received endoscopic nasopharyngectomy and no recurrence of postoperative follow-up. One-year overall survival rate, disease-free survival rate and no local recurrence survival rate were 96.67%, 80.00% and 86.67% respectively. Five-year disease-free survival rate was 61.80%. The progression free survival time was 2-82 （31.87±23.26） months. Multivariate analysis showed that sex, age, first diagnosed T stage, and tumor necrosis were not the independent prognostic factor for survival in recurrent nasopharyngeal carcinoma patients.ConclusionsEndoscopic nasopharyngectomy is a

关 键 词：鼻咽肿瘤 外科学 肿瘤复发 局部 内窥镜检查 预后 因素分析 统计学 

分 类 号：R739.63[医药卫生—肿瘤]