复发性鼻咽癌外科治疗的研究进展  

Research progress in surgical treatment of recurrent nasopharyngeal carcinoma

作　　者：郑实兴 张焕康 薛凯 李万鹏 顾晔 刘全 孙希才 余洪猛 ZHENG Shixing;ZHANG Huankang;XUE Kai;LI Wanpeng;GU Ye;LIU Quan;SUN Xicai;YU Hongmeng(Department of Otolaryngology,Eye&ENT Hospital,Fudan University,Shanghai 200031,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,Shanghai 200003,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]复旦大学附属眼耳鼻喉科医院神经外科,上海200031 [3]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,上海200003

出　　处：《广西医科大学学报》2024年第9期1316-1324,共9页Journal of Guangxi Medical University

基　　金：中国医学科学院医学与健康科技创新工程项目资助(No.2019-I2M-5-003);上海市科学技术委员会科技创新行动计划临床医学项目资助(No.19411950600);上海市卫生健康委员会面上项目资助(No.201940143);上海市科学技术委员会生物医药处西医引导项目资助(No.20Y11902000)。

摘　　要：调强放疗(IMRT)技术的应用显著提高了鼻咽癌(NPC)患者的总体生存率和局部控制率,但仍有10%左右的局部复发率,而再程放疗可能引起严重的并发症。近年来,内镜手术成为复发性NPC的主要外科治疗方案,然而复发性NPC病变部位复杂且危险,尚未形成外科治疗的专家共识,复发性NPC手术仍是鼻颅底外科的重大挑战和重要议题。本文将从内镜手术对复发性NPC的疗效、局部淋巴结复发的手术方式、新的手术T分期和内镜手术分型、术后切缘阳性处理策略、颈内动脉处理方案、颅底修复手段、可切除标准的重新定义、放射性鼻颅底坏死的治疗以及原发性NPC外科治疗的思考等方面作一综述,并对NPC外科治疗的发展方向进行展望。The application of intensity-modulated radiation therapy(IMRT)has significantly improved the overall survival and local control rates for patients with nasopharyngeal carcinoma(NPC).However,there remains a local recurrence rate of approximately 10%,with salvage radiation therapy potentially leading to severe complications.In recent years,endoscopic surgery has become the primary surgical treatment for recurrent NPC.Nonetheless,the lesion sites of recurrent NPC are complex and risky,and there has yet to be an established expert consensus on surgical treatment strategies.Surgery for recurrent NPC continues to present significant challenges and is a critical topic within skull base surgery.This article will review several aspects of surgical treatment for NPC,including the efficacy of endoscopic surgery for recurrent NPC,surgical approaches for local lymph node recurrence,new surgical T staging and endoscopic surgery classification,strategies for managing positive surgical margins post-operation,internal carotid artery management protocols,skull base reconstruction methods,the redefinition of criteria for resectability,the treatment of radiation-induced necrosis of the skull base,and reflections on the surgical treatment of primary NPC.Additionally,it will provide insights into the future directions of surgical treatment for NPC.

关 键 词：鼻咽癌 外科治疗 颈内动脉 颅底重建 

分 类 号：R739.63[医药卫生—肿瘤]