CAJ | 학술논문

目的探讨鼻咽癌放疗后未控患者挽救性治疗方案,分析手术的治疗效果.方法回顾性分析1993-2009年治疗的鼻咽癌放疗后原发部位局部未控或复发挽救性手术患者84例.病理:鳞癌75例,黏液表皮样癌3例,腺样囊性癌2例,腺鳞癌2例,肌上皮癌1例,未分化癌1例.复发T分级rT1级34例,rT2级27例,rT3级12例,rT4级11例.84例患者中rN0级70例,rN1级9例,rN2级5例.鼻咽部术式:上颌骨外翻进入47例,下颌骨升支切除入路15例,下颌骨裂开入路6例,鼻侧壁切开入路7例,硬腭入路6例,上颌骨切除3例.结果手术切除较彻底57例(67.9％),手术切除不满意27例(32.1％).鼻咽癌合并颈转移14例.总5年生存率43.6％.中位随访27个月.单因素分析显示患者rTNM分期、rT分级、手术是否切除干净、放疗疗程对比、是否合并淋巴转移与患者的预后有关(均P ＜0.01),而病理分化程度与患者预后无关(P＞0.05).Cox多因素回归分析显示是否合并颈转移、是否切除干净是独立的预后影响因素.术后发生局部再复发的病例为35例,远处转移5例,5年随访期内36例死亡,以复发为主要死因.结论鼻咽癌放疗后未控,手术挽救可以获得较好的生存效果.
목적 탐토비인암방료후미공환자만구성치료방안,분석수술적치료효과.방법 회고성분석1993-2009년치료적비인암방료후원발부위국부미공혹복발만구성수술환자84례.병리:린암75례,점액표피양암3례,선양낭성암2례,선린암2례,기상피암1례,미분화암1례.복발T분급rT1급34례,rT2급27례,rT3급12례,rT4급11례.84례환자중rN0급70례,rN1급9례,rN2급5례.비인부술식:상합골외번진입47례,하합골승지절제입로15례,하합골렬개입로6례,비측벽절개입로7례,경악입로6례,상합골절제3례.결과 수술절제교철저57례(67.9％),수술절제불만의27례(32.1％).비인암합병경전이14례.총5년생존솔43.6％.중위수방27개월.단인소분석현시환자rTNM분기、rT분급、수술시부절제간정、방료료정대비、시부합병림파전이여환자적예후유관(균P ＜0.01),이병리분화정도여환자예후무관(P＞0.05).Cox다인소회귀분석현시시부합병경전이、시부절제간정시독립적예후영향인소.술후발생국부재복발적병례위35례,원처전이5례,5년수방기내36례사망,이복발위주요사인.결론 비인암방료후미공,수술만구가이획득교호적생존효과.
Objective To study salvage surgery for persistent or recurrent nasopharyngeal carcinoma after irradiation failure.Methods A total of 84 cases underwent salvage surgery for persistent or recurrent nasopharyngeal carcinoma after irradiation failure between 1993 and 2009 was reviewed.rTNM stage:rT1 34 cases,rT2 27 cases,rT3 12 cases and rT4 11 cases; rNO 70 cases,rN1 9 cases and rN2 5 cases;No with distance metastatis.The salvage surgeries were performed using maxillary swing approach ( 47 cases ), transcervico-mandibulo-palatal approach ( 21 cases ), palate nasopharyngectomy ( 6 cases ), lateral rhinotomy (7 cases ),and maxillectomy (3 cases ). Results Persistent or recurrent nasopharyngeal carcinoma after irradiation failure was resected completely in 57 patients (67.9％)and there were microscopic residual siseases in 27 patients( 32.1％ ).The median follow-up was 27 months.Postoperative recurrence occurred in 35 cases.Thirty-six patients died of recurrence,metastasis and other diseases.The overall 5 year survival rate was 43.6％.Cox regression analysis indicated the complete resection for persistent or recurrent disease and no cervical metastasis were two independent factors affecting survival.Conclusions Salvage surgery for persistent or recurrent nasopharyngeal carcinoma after irradiation failure is an effective treatment.