CAJ | 학술논문

目的探讨鼻腔鼻窦神经内分泌癌的诊断与治疗，分析影响其生存与预后的相关因素．方法回顾性分析2007年1月至2011年12月昆明医科大学第一附属医院耳鼻咽喉科收治的14例鼻腔鼻窦神经内分泌癌患者的诊治经过，并对其生存状况进行随访分析．结果14例患者中，2例确诊后放弃治疗失访，其它12例患者随访1～6 a，5例随访期内死亡，6例随访期内带瘤生存，1例随访期内无瘤生存．单纯鼻内镜下手术切除者2例，1例术后21月死于远处转移，1例带瘤生存，其平均无瘤生存期为9月．手术切除后辅以放疗和/或化疗者8例，随访期内死亡3例，带瘤存活5例，其无瘤生存期平均为20.25月．高选择性血管栓塞、灌注化疗后手术治疗者2例，随访期内均存活，其无瘤生存期平均为为25.5月．分化良好的神经内分泌癌5例，其无瘤生存期平均为25.5月；而分化差的小细胞神经内分泌癌7例，平均无瘤生存期为14.6月．T4N0M0期患者6例，平均无瘤生存期为19月；T3NOM0期患者4例，平均无瘤生存期为12.8月；T2N0M0期患者2例，平均无瘤生存期为33月．结论手术辅以放疗和/或化疗是治疗鼻腔鼻窦神经内分泌癌的有效方法，分化差的小细胞神经内分泌癌预后更差，早期明确诊断、及时综合治疗是提高疗效改善预后的重要途径．
목적탐토비강비두신경내분비암적진단여치료，분석영향기생존여예후적상관인소．방법회고성분석2007년1월지2011년12월곤명의과대학제일부속의원이비인후과수치적14례비강비두신경내분비암환자적진치경과，병대기생존상황진행수방분석．결과14례환자중，2례학진후방기치료실방，기타12례환자수방1～6 a，5례수방기내사망，6례수방기내대류생존，1례수방기내무류생존．단순비내경하수술절제자2례，1례술후21월사우원처전이，1례대류생존，기평균무류생존기위9월．수술절제후보이방료화/혹화료자8례，수방기내사망3례，대류존활5례，기무류생존기평균위20.25월．고선택성혈관전새、관주화료후수술치료자2례，수방기내균존활，기무류생존기평균위위25.5월．분화량호적신경내분비암5례，기무류생존기평균위25.5월；이분화차적소세포신경내분비암7례，평균무류생존기위14.6월．T4N0M0기환자6례，평균무류생존기위19월；T3NOM0기환자4례，평균무류생존기위12.8월；T2N0M0기환자2례，평균무류생존기위33월．결론수술보이방료화/혹화료시치료비강비두신경내분비암적유효방법，분화차적소세포신경내분비암예후경차，조기명학진단、급시종합치료시제고료효개선예후적중요도경．
Objective To study the diagnosis and treatment of neuroendocrine carcinoma of the nasal cavity and paranasal sinuses, and analyse the influencing factors of suvival and prognosis. Methods We retrospectively analyzed the diagnosis and treatment process of 14 patients with sinonasal neuroendocrine carcinoma (SNEC) admitted in The First Affiliated Hospital of Kunming Medical University from 2007 to 2011. All patients were followed up to learn the survival status of them.Results All patients were followed up for one year up to six years except 2 patients who gave up treatment. Five patients died and six survived with good tumor control in the followed up period. Two patients received only endoscopy surgery, and one of them died from lung metastasis in 21 months after operation, and the other one survived with good tumor control, the disease free survival (DFS) was 9 months . Eight patients were treated by endscopy surgery and /or chemo-radiotherapy, three cases died in following-up period, and five of them survivied with good tumor control, and the disease free survival was 20.25 months.Two patients with transcatheter arterial infusion chemotherapy survivied with good tumor control within the follow up period,and the DFS was 25.5 months.Five patients had moderately differentiated SNEC and DFS was 25.5 months. Seven patients had poorly differentiated SNEC with DFS 14.6 months. Six patients were T4N0M0, four patients were T3N0M0, two patients T2N0M0, and their DFS were 19 months, 12.8 months and 33 month, respectively. Conclusions Surgery with radiotherapy and/or chemotherapy is the current treatment method for sinonasal neuroendocrine carcinoma. Small cell neuroendocrine carcinoma with poor differiation displays highly aggressive and poor prognosis. Diagnosis and treatment in early stage is important for good prognosis.