CAJ | 학술논문

目的探讨晚期鼻腔鼻窦恶性肿瘤内镜下外科治疗的疗效.方法回顾性分析2004年1月至2010年10月间解放军总医院收治的晚期的鼻腔鼻窦恶性肿瘤患者49例,按UICC6版标准分期,13期12例、T4a期13例、T4b期24例;病理类型为鳞癌20例,腺癌12例,恶性黑色素瘤8例,嗅神经母细胞瘤6例,横纹肌肉瘤、软骨肉瘤、神经胶质瘤各1例.所有患者均接受单纯鼻内镜手术或辅助鼻外入路根治手术,其中36例术后采用放化疗.随访数据采用Kaplan-Meier法生存分析.结果术中出血200～5000 ml,平均约600 ml;术后未发生术腔(包括颅内)感染,经全量放疗未发生脑脊液鼻漏,失明1例.4例(8.2%)患者随访期内失访.随访期内30例复发转移,部分患者出现多处复发及转移,局部复发是治疗失败的主要原因,占复发病例的86.7%(26例).16例死亡患者中除3例外术前均有颅和(或)眼受累;嗅神经母细胞瘤及神经胶质瘤等其他病理类型组患者预后差,9例患者中随访期内5例患者死亡,其中3例伴颅内转移,目前生存时间尚无超过25个月者.2年和3年总体生存率分别为62.5%和58.4%,2年和3年无瘤生存率为34.2%和21.4%.Log-rank检验证实不同T分期、是否接受术后治疗以及切缘性质对患者无瘤生存率影响差异有统计学意义(x2值分别为7.7、6.8和4.9,P值均<0.05).结论内镜经鼻或鼻外辅助路径下对晚期鼻腔鼻窦恶性肿瘤切除满意,结合术后综合治疗,患者生存率满意,并发症少,是鼻腔鼻窦晚期恶性肿瘤外科治疗的良好术式.
목적 탐토만기비강비두악성종류내경하외과치료적료효.방법 회고성분석2004년1월지2010년10월간해방군총의원수치적만기적비강비두악성종류환자49례,안UICC6판표준분기,13기12례、T4a기13례、T4b기24례;병리류형위린암20례,선암12례,악성흑색소류8례,후신경모세포류6례,횡문기육류、연골육류、신경효질류각1례.소유환자균접수단순비내경수술혹보조비외입로근치수술,기중36례술후채용방화료.수방수거채용Kaplan-Meier법생존분석.결과 술중출혈200～5000 ml,평균약600 ml;술후미발생술강(포괄로내)감염,경전량방료미발생뇌척액비루,실명1례.4례(8.2%)환자수방기내실방.수방기내30례복발전이,부분환자출현다처복발급전이,국부복발시치료실패적주요원인,점복발병례적86.7%(26례).16례사망환자중제3예외술전균유로화(혹)안수루;후신경모세포류급신경효질류등기타병리류형조환자예후차,9례환자중수방기내5례환자사망,기중3례반로내전이,목전생존시간상무초과25개월자.2년화3년총체생존솔분별위62.5%화58.4%,2년화3년무류생존솔위34.2%화21.4%.Log-rank검험증실불동T분기、시부접수술후치료이급절연성질대환자무류생존솔영향차이유통계학의의(x2치분별위7.7、6.8화4.9,P치균<0.05).결론 내경경비혹비외보조로경하대만기비강비두악성종류절제만의,결합술후종합치료,환자생존솔만의,병발증소,시비강비두만기악성종류외과치료적량호술식.
Objective To evaluate the effect of endoscopic surgery for advanced malignant tumors in the nasal cavity and paranasal sinuses. Methods A retrospective data analysis was performed on 49 patients with advanced sinonasal tumors undergoing either an exclusive endoscopic approach or with a complemental approach from January 2004 to October 2010. Forty-nine patients were considered eligible for editions of the UICC staging systems). The histotypes encountered were squamous cell carcinoma 20 cases,adenocarcinoma 12 cases, mucosal melanoma 8 cases, olfactory neuroblastoma 6 cases, others 3 cases.These patients were operated on either by an exclusive endoscopic endonasal approach or with a complementary external approach; 36 patients received adjuvant radiotherapy or/and chemotherapy. The data were analyzed by Kaplan-Meier method and Log-rank test. Results The hemorrhage varied from 200 to 5000 ml during the operation, with an average of 600 ml. The post-operative complications were rare,1 patient lost her sight after operation, and no patient got infected at the site of operation (nor intracranial infection). After full amount of radiotherapy, no cerebrospinal fluid rhinorrhea was found. Four patients ( 8. 2% ) lost to follow-up. Sixteen patients died during the follow-up period, only three of them were without craniocerebral or orbital invasion. Four in 9 patients in the other pathological group (with the pathology of olfactory neuroblastoma or glioma etc) , which had a poor prognosis, died during the follow-up period, of them, 3 had definitive evidence of intracranial metastasis, and none of the nine patients had been followedup beyond 25 months. The 2 and 3 year disease-free rates were 34. 2% and 21.4% , and overall survival rates were 62. 5% and 58. 4% respectively. The T stage, margin status, and whether accepted post operative adjuvant therapy were significant factors in predicting disease recurrence(x2 were 7.7, 4. 9, 6. 8 respectively and P <0.05). Conclusions Now the endoscopic techniques with or without complementary approaches is an effective way for complete tumor removal. With postoperative complementary therapy, it provides a satisfactory survival rate with few side effects and better quality of life.