鼻内镜下手术治疗局部复发性鼻咽癌的疗效初步探讨

发布时间：2018-06-14 16:44

本文选题：复发性鼻咽癌 + 鼻内镜　；参考：《扬州大学》2017年硕士论文

【摘要】：研究背景:鼻咽癌是原发于鼻咽粘膜被覆上皮的一种恶性肿瘤,是我国东南沿海地区居民常见的恶性肿瘤,其恶性程度高,覆盖年龄广,放疗敏感是它的典型特征。对于初发鼻咽癌患者,单纯放射治疗疗效显著。部分鼻咽癌患者可在首程放疗后复发,对于鼻咽癌首程根治性放疗一年后出现复发的,可给予常规外放射二程放疗。鼻咽癌复发时间各有不同,但一般多在首次放疗后2年左右复发。对于二程放疗后再次复发的,以及首程放疗2年后复发的,患者往往由于严重的并发症而无法耐受再次放疗。对于这类鼻咽癌复发患者,外科手术可以较完整切除位于鼻咽部、鼻腔、鼻窦及颅底的肿瘤,避免放射性损伤,提高患者的治疗效果和生存质量。本研究通过对低温等离子、内镜动力切割系统手术治疗局部复发性鼻咽癌的临床疗效进行初步探讨,为今后的临床应用提供依据。目的:通过对鼻内镜下低温等离子、内镜动力切割系统手术治疗复发性鼻咽癌的临床疗效进行分析总结,并将传统开放式手术的临床资料作为参照,初步探讨鼻内镜下手术治疗局部复发性鼻咽癌的近期疗效。方法:收集并整理我科自2012年1月——2016年3月间临床收治诊断明确并经全身麻醉、鼻内镜下手术治疗的20例复发性鼻咽癌患者的病例资料,对低温等离子、内镜切割系统治疗局部复发性鼻咽癌的近期疗效进行初步探讨。本研究中的传统手术方式病例均来自2012年以前的病例档案搜集。结果:20例患者全部在鼻内镜下完成手术,术后鼻内镜及影像学检查可见鼻咽癌复发病变均获得较完整切除。术后病理示:非角化型癌9例,鳞状细胞癌5例,低分化癌2例,浆细胞瘤1例,腺癌1例,纤维肉瘤1例,炎性坏死、中心见癌灶1例。鼻内镜低温等离子组术中出血为5-15ml,手术时间为20-40min。鼻内镜动力切割系统组术中出血为100-400ml,手术时间为120-210min。手术并发症情况:低温等离子组8例患者中1例术后出现咽部肿胀,1例出现轻度吞咽时异物感,术后两年内均无复发。鼻内镜动力系统组1例患者术后并发颅内出血死亡,1例侵犯眼球行眼球摘除,1例患者并发糖尿病死亡。术后两年有2例患者复发。20例患者术后回访12-48个月,1年总生存率100%,3年生存率90%。死亡2例,复发2例,余下病例近期复查未见复发,局部控制率为80%。结论:(1)鼻内镜下直视手术能够完整的切除鼻咽癌一期放疗后复发的病变,为鼻咽癌患者一期放疗后复发提供除传统手术治疗之外的确实有效的治疗方法。(2)低温等离子应用于鼻咽癌放疗后局部复发患者的挽救性治疗,具有损伤小、出血少、恢复快、并发症少等优点。本研究病例较少,但作为放疗复发的补救治疗,只要手术适应证选择得当,可在今后的临床研究中扩大样本量,采用前瞻性研究。
[Abstract]:Background: nasopharyngeal carcinoma (NPC) is a malignant tumor of nasopharyngeal mucosa coated epithelium. It is a common malignant tumor in the southeast coastal area of China. Its malignant degree is high, it covers a wide range of ages, and it is sensitive to radiotherapy. For primary nasopharyngeal carcinoma, radiotherapy alone is effective. Some patients with nasopharyngeal carcinoma can recur after first stage radiotherapy, and for those with recurrence one year after the first stage of radical radiotherapy, conventional external radiotherapy can be given. The recurrence time of nasopharyngeal carcinoma varies, but it usually recurres about 2 years after the first radiotherapy. For those who recur again after two-course radiotherapy and 2 years after first-stage radiotherapy patients are often unable to tolerate re-radiotherapy due to severe complications. For the patients with recurrent nasopharyngeal carcinoma, the tumor located in nasopharynx, nasal cavity, sinuses and skull base can be removed completely by surgery, which can avoid radiation damage and improve the therapeutic effect and quality of life of the patients. In this study, the clinical effect of low temperature plasma and endoscopic dynamic cutting system in the treatment of local recurrent nasopharyngeal carcinoma (RNPC) was preliminarily discussed in order to provide the basis for clinical application in the future. Objective: to analyze and summarize the clinical effect of endoscopic hypothermic plasma and endoscopic dynamic cutting system in the treatment of recurrent nasopharyngeal carcinoma, and to make reference to the clinical data of traditional open surgery. Objective: to evaluate the short-term efficacy of endoscopic sinus surgery in the treatment of local recurrent nasopharyngeal carcinoma. Methods: the data of 20 patients with recurrent nasopharyngeal carcinoma treated by general anesthesia and endoscopic surgery from January 2012 to March 2016 were collected and analyzed. The short-term curative effect of endoscopic cutting system for local recurrent nasopharyngeal carcinoma (RNPC) was preliminarily discussed. The traditional surgical procedures in this study were collected from case files before 2012. Results all the 20 cases were operated under nasal endoscope. The recurrence of nasopharyngeal carcinoma was resected completely by endoscopic and imaging examination. Postoperative pathology showed that 9 cases of non-keratinized carcinoma, 5 cases of squamous cell carcinoma, 2 cases of poorly differentiated carcinoma, 1 case of plasmacytoma, 1 case of adenocarcinoma, 1 case of fibrosarcoma, 1 case of inflammatory necrosis, and 1 case of central carcinoma. In the nasal endoscope hypothermic plasma group, the intraoperative bleeding was 5-15 ml and the operative time was 20-40 min. The intraoperative bleeding was 100-400 ml and the operative time was 120-210 min in the endoscopic dynamic cutting system group. Complications: in hypothermic plasma group, one patient developed pharynx swelling and 1 patient developed foreign body sensation of mild swallowing after operation, and no recurrence occurred within two years after operation. In the nasal endoscope dynamic system group, 1 patient died of intracranial hemorrhage after operation and 1 patient suffered from enucleation of the eyeball and 1 patient died of diabetes mellitus. There were 2 cases of recurrence and 20 cases of recurrence in two years after operation. The 1 year overall survival rate was 100 and the 3 year survival rate was 90. There were 2 cases of death and 2 cases of recurrence. No recurrence was found in the remaining cases, and the local control rate was 80%. Conclusion the endoscopic direct surgery can completely remove the recurrent lesions of nasopharyngeal carcinoma after primary radiotherapy. In addition to the traditional surgical treatment, hypothermic plasma is used to rescue the local recurrence patients after radiotherapy of nasopharyngeal carcinoma. It has the advantages of less injury, less bleeding, and faster recovery. Fewer complications and other advantages. There are few cases in this study, but as a remedial treatment for radiotherapy recurrence, if the surgical indications are properly selected, the sample size can be expanded in the future clinical study and prospective study is adopted.
【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R739.63

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