内镜经口入路岩斜区、颈静脉孔区鼻咽癌切除术  

Endoscopic transoral approach nasopharyngectomy for petroclival and jugular foramen nasopharyngeal carcinoma

作　　者：张焕康 李静[2] 蒋晓文 李帅 薛凯 孙希才 刘全 顾晔 李万鹏 宋小乐 余洪猛 Zhang Huankang;Li Jing;Jiang Xiaowen;Li Shuai;Xue Kai;Sun Xicai;Liu Quan;Gu Ye;Li Wanpeng;Song Xiaole;Yu Hongmeng(Department of Otorhinolaryngology,Eye&ENT Hospital,Fudan University,Shanghai 200031,China;Department of Otorhinolaryngology,Affiliated Hangzhou First People′s Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Department of Otorhinolaryngology,Huazhong University of Science and Technology Union Shenzhen Hospital(Nanshan Hospital),Shenzhen 518052,China;Department of Otorhinolaryngology,Jiangmen Central Hospital of Guangdong Province,Jiangmen 529030,China;Department of Neurosurgery,Eye&ENT Hospital,Fudan University,Shanghai 200031,China;Research Units of New Technologies of Endoscopic Surgery in Skull Base Tumor,Chinese Academy of Medical Sciences(2018RU003),Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻咽喉科,上海200031 [2]浙江大学医学院附属杭州市第一人民医院耳鼻咽喉科,杭州310003 [3]华中科技大学协和深圳医院(南山人民医院)耳鼻咽喉科,深圳518052 [4]广东省江门市中心医院耳鼻咽喉科,江门529030 [5]复旦大学附属眼耳鼻喉科医院神经外科,上海200031 [6]中国医学科学院内镜下鼻颅底肿瘤外科治疗技术创新单元(2018RU003),上海200031

出　　处：《中华耳鼻咽喉头颈外科杂志》2023年第1期21-27,共7页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：中国医学科学院医学与健康科技创新工程项目(2019-I2M-5-003);国家自然科学基金面上项目(81970856);上海市科学技术委员会科技创新行动计划基础研究项目(21JC1401100);上海市徐汇区人工智能医疗院地合作项目(2021-008);国家临床重点专科建设项目(Z155080000004)。

摘　　要：目的探索内镜经口入路的解剖要点及其在岩斜区和颈静脉孔区复发性鼻咽癌(nasopharyngeal carcinoma, NPC)手术中的应用。方法使用3个干性头颅骨性标本和5个新鲜冰冻尸头标本, 采用经口入路显露岩斜区和颈静脉孔区, 记录重要解剖标志及显露范围, 详细介绍该入路的手术方法和技巧。回顾性分析于2020年6月至2022年4月就诊于复旦大学附属眼耳鼻喉科医院的复发性NPC患者6例, 男女比例1∶1, 年龄42~69岁, 所有患者均使用该入路行岩斜区和颈静脉孔区复发性NPC切除术。采用描述性方法进行分析。结果解剖研究显示, 内镜经口入路在保留翼内肌和翼外肌的基础上, 可显露咽旁段、岩骨段和斜坡旁段颈内动脉, 可处理颈静脉孔区和岩斜区的病变。临床实践显示, 6例患者均成功行内镜经口入路NPC切除术, 术后增强MRI见肿瘤完整切除, 患者无咀嚼功能障碍。结论内镜经口入路用于岩斜区和颈静脉孔区复发性NPC切除术, 具有安全、微创、可靠的特点, 值得临床推广。Objective To describe a technique of endoscopic transoral approach nasopharyngectomy for petroclival and jugular foramen nasopharyngeal carcinoma,based on anatomic studies and surgeries.Methods Three dry human skulls and five fresh human cadaver heads were used for anatomic study of a endoscopic transoral approach to expose petroclival and jugular foramen.The anatomical landmarks and the extent of exposure were recorded.Six clinical cases who were treated in Eye&ENT Hospital,Fudan University from June 2020 to April 2022 were used to illustrate the technique and feasibility of this approach and to assess its indications and advantages,including 3 males and 3 females,aged 42 to 69 years old.Descriptive analysis was used in this research.Results On the basis of the preservation of the internal pterygoid muscle and the external pterygoid muscle,this approach could fully expose the parapharyngeal,petrosal and paraclival segment internal carotid arteries,and safely deal with the lesions of jugular foramen and petroclival region.The 6 patients in our study tolerated the procedure well.Postoperative enhanced MRI showed complete resection of the tumor and no postoperative masticatory dysfunction.Conclusion Endoscopic transoral approach is a safe,minimally invasive and effective surgical treatment for petroclival and jugular foramen recurrent nasopharyngeal carcinoma.

关 键 词：经口 翼突后 复发性鼻咽癌 岩斜区 颈静脉孔区 

分 类 号：R739.63[医药卫生—肿瘤]