中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2015年
11期
896-903
,共8页
鼻咽肿瘤%内窥镜检查%鼻外科手术%生活质量
鼻嚥腫瘤%內窺鏡檢查%鼻外科手術%生活質量
비인종류%내규경검사%비외과수술%생활질량
Nasopharyngeal neoplasms%Endoscopy%Nasal surgical procedures%Quality of life
目的 探讨鼻咽癌治疗后残留或复发患者的内镜救援手术的临床疗效,分析术后接受不同治疗方式及不同rTNM分期患者的生活质量.方法 回顾性分析2009年6月至2015年3月因鼻咽癌残留或复发行内镜救援手术的96例患者的临床资料.病理:非角化性未分化型癌76例,鳞状细胞癌20例.rTNM分期:rⅠ期20例,rⅡ期16例,rⅢ期44例,rⅣ期16例.rT1级22例,rT2级16例,rT3级42例,rT4级16例.rN0 92例,rN1 2例,rN2 2例.全部患者均行内镜下鼻咽颅底肿物切除术,合并颈部复发者同时行根治性颈淋巴清扫术.并对随访存活的62例患者采用QLQ-C30和QLQ-H&N35进行生活质量评估和比较.采用SPSS 19.0软件进行统计学分析.结果 96例患者中内镜下全切44例(45.8％),次全切除52例(54.2％).术后随访死亡34例,其中Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者分别为2例(5.9％)、2例(5.9％)、18例(52.9％)、12例(35.3％).患者1、2、3年累积生存率分别为83％、68％、63％,中位生存期为43个月.Kaplan-Meier单因素分析显示,病理类型、rTNM分期、rT分级、术后不同治疗方式、手术切缘与患者的预后有关(P值均＜0.05).Cox多因素分析提示,病理类型、手术切缘为影响患者预后的独立危险因素(P值均＜0.05).生活质量调查结果显示,单纯手术组患者优于术后化疗组和术后放化疗组(P值均＜0.05).结论 内镜手术治疗鼻咽癌残留或复发可使患者获得较好的生存率,同时可提高患者术后生活质量,而术后增加放化疗将严重影响其生活质量.
目的 探討鼻嚥癌治療後殘留或複髮患者的內鏡救援手術的臨床療效,分析術後接受不同治療方式及不同rTNM分期患者的生活質量.方法 迴顧性分析2009年6月至2015年3月因鼻嚥癌殘留或複髮行內鏡救援手術的96例患者的臨床資料.病理:非角化性未分化型癌76例,鱗狀細胞癌20例.rTNM分期:rⅠ期20例,rⅡ期16例,rⅢ期44例,rⅣ期16例.rT1級22例,rT2級16例,rT3級42例,rT4級16例.rN0 92例,rN1 2例,rN2 2例.全部患者均行內鏡下鼻嚥顱底腫物切除術,閤併頸部複髮者同時行根治性頸淋巴清掃術.併對隨訪存活的62例患者採用QLQ-C30和QLQ-H&N35進行生活質量評估和比較.採用SPSS 19.0軟件進行統計學分析.結果 96例患者中內鏡下全切44例(45.8％),次全切除52例(54.2％).術後隨訪死亡34例,其中Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者分彆為2例(5.9％)、2例(5.9％)、18例(52.9％)、12例(35.3％).患者1、2、3年纍積生存率分彆為83％、68％、63％,中位生存期為43箇月.Kaplan-Meier單因素分析顯示,病理類型、rTNM分期、rT分級、術後不同治療方式、手術切緣與患者的預後有關(P值均＜0.05).Cox多因素分析提示,病理類型、手術切緣為影響患者預後的獨立危險因素(P值均＜0.05).生活質量調查結果顯示,單純手術組患者優于術後化療組和術後放化療組(P值均＜0.05).結論 內鏡手術治療鼻嚥癌殘留或複髮可使患者穫得較好的生存率,同時可提高患者術後生活質量,而術後增加放化療將嚴重影響其生活質量.
목적 탐토비인암치료후잔류혹복발환자적내경구원수술적림상료효,분석술후접수불동치료방식급불동rTNM분기환자적생활질량.방법 회고성분석2009년6월지2015년3월인비인암잔류혹복발행내경구원수술적96례환자적림상자료.병리:비각화성미분화형암76례,린상세포암20례.rTNM분기:rⅠ기20례,rⅡ기16례,rⅢ기44례,rⅣ기16례.rT1급22례,rT2급16례,rT3급42례,rT4급16례.rN0 92례,rN1 2례,rN2 2례.전부환자균행내경하비인로저종물절제술,합병경부복발자동시행근치성경림파청소술.병대수방존활적62례환자채용QLQ-C30화QLQ-H&N35진행생활질량평고화비교.채용SPSS 19.0연건진행통계학분석.결과 96례환자중내경하전절44례(45.8％),차전절제52례(54.2％).술후수방사망34례,기중Ⅰ、Ⅱ、Ⅲ、Ⅳ기환자분별위2례(5.9％)、2례(5.9％)、18례(52.9％)、12례(35.3％).환자1、2、3년루적생존솔분별위83％、68％、63％,중위생존기위43개월.Kaplan-Meier단인소분석현시,병리류형、rTNM분기、rT분급、술후불동치료방식、수술절연여환자적예후유관(P치균＜0.05).Cox다인소분석제시,병리류형、수술절연위영향환자예후적독립위험인소(P치균＜0.05).생활질량조사결과현시,단순수술조환자우우술후화료조화술후방화료조(P치균＜0.05).결론 내경수술치료비인암잔류혹복발가사환자획득교호적생존솔,동시가제고환자술후생활질량,이술후증가방화료장엄중영향기생활질량.
Objective To explore the clinical efficacy of patients who underwent endoscopic salvage nasopharyngectomy for residual or recurrent nasopharyngeal carcinoma (rNPC) after irradiation failure, and examine the quality of life(QOL) of them who were at different tumor stage and given different postoperative treatment.Methods Ninety-six patients who underwent endoscopic salvage nasopharyngectomy for rNPC between June 2009 and March 2015 were retrospectively reviewed.rTNM stage: 20 cases were at stage Ⅰ , 16 at stage Ⅱ,44 at stage Ⅲ,16 at stage Ⅳ;rT1 22 cases(22.9％) ,rT2 16 cases(16.7％) ,rT3 42 cases (43.8％) ,rT4 16 cases(16.7％);rN0 92 cases(95.8％) ,rN1 2 cases(2.1％) ,rN2 2 cases(2.1％);No with distance metastasis.All the patients underwent endoscopic resection of lesions, and four cases with cervical metastasis received neck dissection at the same time.Postoperatively the self-reported, health-related QOL questionnaires were used to assess and compare the QOL of survival patients.SPSS 19.0 software was used to analyzed the data.Results The overall 1 year survival rates (SR), 2 year SR, 3 year SR were 83％ ,68％ ,63％, respectively.The median follow-up was 43 months.Cox regression analysis indicated the complete resection for rNPC and pathology were two independent factors affecting survival.The QOL of patients who received endoscopic salvage nasopharyngectomy only were better than the patients who received concurrent chemoradiation therapy or chemotherapy.Conclusions The patients who underwent endoscopic salvage nasopharyngectomy for rNPC had a good survival rates and QOL.
