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目的探讨鼻咽癌放疗后鼻咽部复发挽救性手术入路的方法和效果。方法1998年1月—2003年1月对13例鼻咽癌放疗后鼻咽部复发进行挽救性手术治疗。手术采用经口腔硬腭入路2例,鼻锥内翻入路2例,上颌骨外旋入路5例,经颞下窝入路4例,术后随访2～5年。回顾性分析4种不同的手术路径与方法、适应证以及治疗效果。结果T1和T2a各2例患者经硬腭入路和鼻锥内翻入路,随访生存均达3年以上。3例T2b和2例T3上颌骨外旋入路,分别在术后2个月、2年死亡,1例术后复发光敏治疗后带瘤生存13个月死亡;2例健在,随访分别达2年和4年。T44例经颞下窝入路,术后咬)功能均有影响,术后1年内死亡3例,1例随访2年健在。13例均无术中并发症,术后发生鼻咽部颅底骨坏死、脑脊液漏并发颅内感染、上消化道大出血各1例,2年生存率54%(7/13)。结论根据鼻咽复发肿瘤的部位、侵犯范围,以尽可能小的创伤获得足够的显露的原则选择手术入路。T1和T2病变可外科手术根治,手术效果良好。肿瘤侵犯咽旁组织和中耳者,预后较差,手术可以减轻患者痛苦,延长生命。
Objective To investigate the method and effect of nasopharyngeal resection salvage surgery after radiotherapy for nasopharyngeal carcinoma. Methods From January 1998 to January 2003, 13 cases of nasopharyngeal recurrence after nasopharyngeal carcinoma were treated by salvage operation. Surgical use of the oral hard palate approach in 2 cases, 2 cases of nasal cone inversion approach, 5 cases of maxillary external rotation approach, the infratemporal fossa approach in 4 cases, followed up for 2 to 5 years. Retrospective analysis of four different surgical paths and methods, indications and treatment. Results Two cases of T1 and T2a were treated with hard palate approach and nasal cone inversion approach respectively. The patients were followed up for more than 3 years. 3 cases of T2b and 2 cases of T3 maxillary extracorporeal approach, respectively, 2 months after surgery, 2 years of death, 1 case of postoperative recurrence of light-sensitive treatment of tumor survival after 13 months of death; 2 cases were alive, up to 2 Years and 4 years. T44 cases underwent infratemporal fossa approach and postoperative bite, all of which had an effect on the function, 3 cases died within 1 year after operation and 1 case was followed up for 2 years. None of the 13 cases had intraoperative complications. One case of upper cranial bone necrosis, one case of upper cerebrospinal fluid leakage and one case of upper gastrointestinal bleeding were found. The 2-year survival rate was 54% (7/13). Conclusion According to the site of nasopharyngeal tumor recurrence, the extent of violations, the smallest possible trauma to obtain adequate exposure to the principle of choice of surgical approach. T1 and T2 lesions can be cured by surgery, the operation effect is good. Tumor invasion of the parapharyngeal tissue and the middle ear, the prognosis is poor, surgery can reduce patient pain and prolong life.