内镜下上颌骨全切术在鼻腔鼻窦腺样囊性癌治疗中的应用  

The outcome of transnasal endoscopic total maxillectomy in the treatment of sinonasal adenoid cystic carcinoma

作　　者：刘全 赖玉婷 杨婧艺 张焕康 孙希才 顾瑜蓉 李厚勇 余洪猛 王德辉 LIU Quan;LAI Yuting;YANG Jingyi;ZHANG Huankang;SUN Xicai;GU Yurong;LI Houyong;YU Hongmeng;WANG Dehui(Department of Otorhinolaryngology Head and Neck Surgery,Eye and ENT Hospital,Fudan University,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头颈外科,上海200031

出　　处：《临床耳鼻咽喉头颈外科杂志》2023年第4期243-246,251,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:分析内镜下上颌骨全切术治疗广泛累及硬腭的鼻腔鼻窦腺样囊性癌(SACC)的预后。方法:回顾性分析2014年5月—2020年12月期间因SACC而行内镜下上颌骨全切术的26例患者的临床资料,采用Kaplan-Meier法和Cox回归检验模型进行生存分析和预后因素分析。利用咀嚼功能评估量表对患者术后佩戴牙托的咀嚼功能进行评估。结果:8例(30%)患者术后切缘阳性,中位随访时间为38个月(6~85个月),死亡4例,远处转移4例,5年总累积生存率和无复发生存率分别为79.5%和89.1%。Cox回归显示切缘阳性(P=0.018)、肿瘤复发(P=0.006)和远处转移(P=0.04)是影响预后的独立因素。结论:内镜下上颌骨全切术可对广泛累及硬腭的SACC进行根治性切除。切缘阳性、肿瘤局部复发和远处转移是影响SACC患者预后的重要因素。Objective: To assess the prognosis of sinonasal adenoid cystic carcinoma with hard palatine invasion treated by transnasal endoscopic total maxillectomy.Methods: Clinical data of twenty-six patients with sinonasal adenoid cystic carcinoma invading hard palatine treated by transnasal endoscopic total maxillectomy between May 2014 and December 2020 was analyzed retrospectively.Survival rate,local recurrence and distant metastasis were analyzed using Kaplan-Meier method.Cox regression was used to investigate the prognosis factors.Masticatory function after maxillectomy has also been assessed using the questionnaire of patients'satisfaction about masticatory function.Results: Margins in 8 patients(30%)were positive.The median time of follow-up was 38 months(6 to 85 months).Twenty-five patients recurred.Four patients died of distant metastasis.The 5-year overall survival rate and relapse-free survival rate was 79.5%and 89.1%,respectively.Independent predictors of outcome on multivariate analysis were positive margin(P=0.018),recurrence(P=0.006)and distant metastasis(P=0.04).Conclusion: Transnasal endoscopic total maxillectomy could be performed for the treatment of the sinonasal adenoid cystic carcinoma with hard palatine invasion.Positive margin,local recurrence and distant metastasis were important predictors for patients'prognosis.

关 键 词：上颌窦肿瘤 腺样囊性癌 上颌骨全切术 内镜外科手术 预后 

分 类 号：R739.62[医药卫生—肿瘤]