Kadish C期嗅神经母细胞瘤行鼻内镜手术切除及综合治疗的临床分析  

Clinical analysis of endonasal endoscopic resection and comprehensive treatment in Kadish C esthesioneuroblastoma

作　　者：孙炎[1] 黄谦[1] 崔顺九[1] 张娜[2] 黄振效 张树荣[3] 杨本涛[4] 邱鄂[5] 王明婕[1] 曲静 周兵[1] SUN Yan;HUANG Qian;CUI Shunjiu;ZHANG Na;HUANG Zhenxiao;ZHANG Shurong;YANG Bentao;QIU E;WANG Mingjie;QU Jing;ZHOU Bing(Department of Otolaryngology Head and Neck Surgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Otolaryngology Head and Neck Surgery,Qinhuangdao First Hospital,Hebei Medical University,Qinhuangdao 066000,China;Department of Oncology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Radiology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Neurosurgery,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,北京100730 [2]秦皇岛市第一医院耳鼻咽喉头颈外科,河北秦皇岛066000 [3]首都医科大学附属北京同仁医院肿瘤科,北京100730 [4]首都医科大学附属北京同仁医院影像科,北京100730 [5]首都医科大学附属北京同仁医院神经外科,北京100730

出　　处：《中国耳鼻咽喉颅底外科杂志》2020年第2期114-120,共7页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：国家自然科学基金资助(81770977);北京市医院管理局“登峰”计划专项经费资助(DFL20150202);首都医科大学附属北京同仁医院重点医学专项基金资助课题(trzdyxzy201702);北京市科学技术委员会资助(Z181100001718103)。

摘　　要：目的回顾性分析Kadish C期嗅神经母细胞瘤行鼻内镜手术切除及综合治疗的效果,探讨手术适应证、方法及围术期管理经验。方法收集2004年12月-2018年9月首都医科大学附属北京同仁医院接受鼻内镜手术并证实为Kadish C期嗅神经母细胞瘤患者17例的临床资料。其中男13例,女4例;年龄26~67岁,平均45.4岁。所有患者术前均行鼻窦CT和MRI、颈部超声及胸部CT检查。采用Kaplan-Meier法进行生存分析、计算总体生存率和无瘤生存率。结果17例患者中初次手术11例,术后复发再次手术6例。所有患者均行鼻内镜手术切除,12例患者行颅底重建,其中10患者切除硬脑膜和嗅球。术后病理确诊为嗅神经母细胞瘤,病理采用Hyams评分系统进行病理分级,Ⅱ级9例,Ⅲ级8例。16例辅助放疗;8例辅助化疗,其中4例接受术前诱导化疗。无严重手术并发症;随访8~109个月,平均随访44.2个月,失访1例,复发和/或转移4例。死亡3例,均死于肿瘤脑转移。1年和5年总体生存率为94.1%和80.7%,1年和5年无瘤生存率为76.5%。结论Kadish C嗅神经母细胞瘤采用鼻内镜切除加术后辅助综合治疗可以获得满意的5年生存率;术者经验和技术及多层颅底重建修复是手术成功的关键。Objective To analyze the efficacy of endonasal endoscopic resection and comprehensive treatment for Kadish C esthesioneuroblastoma retrospectively and to explore the surgical indications, strategy and perioperative management.Methods A total of 17 patients with Kadish C esthesioneuroblastoma who underwent endonasal endoscopic surgery in our department from Dec 2004 to Sept 2018 were collected. There were 13 males and 4 females. Sinus computed tomography(CT) and magnetic resonance imaging(MRI) examination, neck ultrasound and lung CT examination were performed preoperatively. Survival analyses were calculated based on the Kaplan-Meier method.Results Eleven patients presented with newly diagnosed disease and six were treated for tumor recurrence. All patients underwent endoscopic surgery, Skull base reconstruction was performed in 12 patients, and 10 of them underwent resection of dura and olfactory bulb. Postoperative pathology confirmed the diagnosis of olfactory neuroblastoma, with 9 cases of Hyams Grade 2 and 8 of Grade 3. Sixteen patients received radiotherapy and 8 received chemotherapy including preoperative induction chemotherapy in 4. No serious complications were observed. The patients were followed up for 8 to 109 months, with an average of 44.2 months. One case lost follow-up, 4 had recurrence and 3 died of brain metastasis. The 1-year and 5-year overall survival rates were 94.1% and 80.7%, and the 1-year and 5-year tumor-free survival rates were both 76.5%.Conclusions Combined treatment of Kadish C esthesioneuroblastoma with endonasal endoscopic resection and postoperative radiotherapy can achieve a satisfactory 5-year survival rate. The experience and skill of the surgeon as well as the multi-layer reconstruction of skull base are the keys to the success of operation.

关 键 词：鼻内镜 嗅神经母细胞瘤 放疗 化疗 带血管蒂 鼻中隔黏膜瓣 外科手术 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]