CAJ | 학술논문

目的根据鼻咽癌局部复发和残留累及的部位和范围,选择不同手术进路切除肿瘤,观察治疗效果、并发症,并观察其预后.方法回顾性分析从1991年3月至2005年1月因首次治疗失败、手术挽救治疗的鼻咽癌患者37例,男23例,女14例;年龄26～57岁,中位年龄46.5岁.Ⅰ期4例,Ⅱ期10例,Ⅲ期14例,Ⅳ期9例.5例患者颈部淋巴结复发.37例患者经活检证实为鼻咽癌复发和残留.行鼻内镜手术8例,硬腭进路12例,上颌骨外翻进路5例,上颌骨外翻进路+翼点入路4例,鼻侧切+冠状切口双额开颅进路2例,面中部切口鼻锥体翻转进路6例.其中5例同时行颈淋巴清扫术.31例术后2周放疗60 Gy,其中放疗同期化疗15例;6例切缘组织为阴性者未予放疗及化疗.中位随访时间45个月(12～72个月).Kaplan-Meier法计算生存率.结果91.8%(34/37)患者复发肿瘤完全切除,次全切除8.2%(3/37).手术并发症发生率24.3%(9/37).总的3年和5年无瘤生存率分别为62.1%和43.3%.总的3年和5年生存率分别为72.9%和51.3%.Ⅰ～Ⅳ期复发患者的5年无瘤生存率分别为100%、40%、28%和1l%(χ2=10.0,P＜0.01＝,5年累积生存率为100%、70%、35%和28%(χ2=11.5,P＜0.01),差异有统计学意义.结论鼻咽癌复发手术挽救治疗是可行的.根据鼻咽癌复发灶具体部位和范围,采用一种手术进路方法或加以改良,或联合神经外科进路,术中使肿瘤充分暴露,可以安全切除病变,挽救局部复发晚期鼻咽癌患者.
목적 근거비인암국부복발화잔류루급적부위화범위,선택불동수술진로절제종류,관찰치료효과、병발증,병관찰기예후.방법 회고성분석종1991년3월지2005년1월인수차치료실패、수술만구치료적비인암환자37례,남23례,녀14례;년령26～57세,중위년령46.5세.Ⅰ기4례,Ⅱ기10례,Ⅲ기14례,Ⅳ기9례.5례환자경부림파결복발.37례환자경활검증실위비인암복발화잔류.행비내경수술8례,경악진로12례,상합골외번진로5례,상합골외번진로+익점입로4례,비측절+관상절구쌍액개로진로2례,면중부절구비추체번전진로6례.기중5례동시행경림파청소술.31례술후2주방료60 Gy,기중방료동기화료15례;6례절연조직위음성자미여방료급화료.중위수방시간45개월(12～72개월).Kaplan-Meier법계산생존솔.결과91.8%(34/37)환자복발종류완전절제,차전절제8.2%(3/37).수술병발증발생솔24.3%(9/37).총적3년화5년무류생존솔분별위62.1%화43.3%.총적3년화5년생존솔분별위72.9%화51.3%.Ⅰ～Ⅳ기복발환자적5년무류생존솔분별위100%、40%、28%화1l%(χ2=10.0,P＜0.01＝,5년루적생존솔위100%、70%、35%화28%(χ2=11.5,P＜0.01),차이유통계학의의.결론비인암복발수술만구치료시가행적.근거비인암복발조구체부위화범위,채용일충수술진로방법혹가이개량,혹연합신경외과진로,술중사종류충분폭로,가이안전절제병변,만구국부복발만기비인암환자.
Objective The choice of surgical approaches for salvage surgery based on the location and invasion of recurrent and residual lesions of nasopharyngeal carcinoma (NPC),surgical results,complications,and survival were assessed.Methods Thirty-seven cases with recurrent and residual lesions of NPC underwent salvage surgery between March 1991 and January 2005 were analysed retrospectively.Of 37 patients,23 were men and 14 women,with a median age of 46.5 years (26 -57 years) ;4 were at stage Ⅰ,10 at stage Ⅱ,14 at stage Ⅲ,and 9 at stage Ⅳ; 5 cases were with cervical metastasis,including 3 cases of N1 and 2 cases N2.All recurrent and residual lesions of NPC were determined by biopsy.On the location and invasion of recurrent and residual lesions of NPC,8 cases underwent endoscopic resection of lesions,12 cases of the palate nasopharyngectomy,5 cases of maxillary swing,4 cases of maxillary swing plus preronal approach,2 cases of lateral rhinotomy plus coronalflap approach,and 6 cases transfacial plus nasal pyramid swing approach.Five cases with cervical metastasis received neck dissection in addition to the operations for recurrent and residual lesions of NPC. Postoperatively 31 cases received radiotherapy with dosage of 60 Gy,among them 15 cases with concurrent chemoradiation therapy,and 6 cases with clear surgical margin did not received radiotherapy or chemotherapy. The cases were followed up for 12 - 72 months,with a median of 45 months.Results Total resection for the recurrent and residual lesions of NPC acounted for 91.8% (34/37) and subtotal resection for 8.2% (3/37). The accidence of perioperative complications was 24.3% (9/37). The 3- and 5-year overall disease-free survival rates (DFSR) were 62.1% and 43.3%,respectively. The 3- and 5-year overall survival rates (OSR) were 72.9% and 51.3%,respectively.The 5 year DFSR of cases at stage Ⅰ - Ⅳ were 100%,40%,28% and 11% (χ2 =10.0,P ＜0.01＝,respectively.The 5 year OSR were 100%,70%,35% and 28% (χ2 = 11.5,P ＜0.01),respectively.Conclusions Salvage surgery is a justified treatment for the recurren and residual lesions of NPC,by which some patients with recurren and residual lesions of NPC can be salvaged.