局部复发鼻咽癌的外科挽救治疗  

Salvage Surgery of Local Recurrent Nasopharyngeal Carcinoma

作　　者：丁茜 陈明远[1,2] DING Xi;CHEN Mingyuan(Department of Nasopharyngeal Carcinoma,Sun Yat-sen University Cancer Center,Guangzhou 510060,China;State Key Laboratory of Oncology in South China,Collaborative Innovation Center for Cancer Medicine,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy,Guangzhou 510060,China)

机构地区：[1]中山大学肿瘤防治中心鼻咽科,广州510060 [2]华南肿瘤学国家重点实验室,肿瘤医学协同创新中心,广东省鼻咽癌诊治重点实验室,广州510060

出　　处：《肿瘤防治研究》2020年第4期235-242,共8页Cancer Research on Prevention and Treatment

摘　　要：鼻咽癌放疗后约10%~36%的患者复发。复发病灶通常对放疗不敏感,再程放疗疗效不佳,且会导致严重并发症,而外科治疗可以根治性切除癌灶并避免二次照射,成为复发鼻咽癌理想的挽救治疗方法。鼻外入路挽救手术创伤较大,且均存在不同程度的手术并发症。经鼻内镜鼻咽切除术因微创、切除范围不亚于鼻外入路,逐步成为rT1~2及部分rT3期患者的首选方案,相应的外科分期为复发鼻咽癌的分层治疗提供了科学依据。颈内动脉栓塞术、颅内外血管搭桥术等新技术的运用正在扩大挽救手术适应证,但广泛的外科切除是否优于二程放疗仍需更多实践验证。There are 10%-36%of nasopharyngeal carcinoma patients suffering from local and/or regional recurrence after primary treatment.The efficacy of re-irradiation to recurrent NPC(rNPC)has been suboptimal.Moreover,the adjacent sensitive organs had already received a high dose of radiation,thus the re-irradiation could result in severe radiation-related complications.Surgery could remove the radiation-resistant lesion directly and avoid complications of re-irradiation,therefore,salvage surgery has been well established and become the first-line treatment for rNPC.Various open surgical approaches had been devised for nasopharyngectomy but presented many surgical complications.In recent decade,the endoscopic nasopharyngectomy(ENPG)had gained popularity for rT1-2 and selected rT3 patients with its minimal invasiveness and the resection range is similar to most open surgeries.Additionally,a new Surgical Staging System established to aid clinicians in choosing the most suitable treatment for rNPC patients.Nowadays,the utilization of extracranial/intracranial vascular bypass and internal carotid artery embolization is widening the indications of salvage surgery,while whether the extended resection exhibits better survival than re-irradiation needs further clinical evidence.

关 键 词：复发 鼻咽癌 挽救性手术 鼻咽切除术 内镜手术 

分 类 号：R739.6[医药卫生—肿瘤]