鼻咽癌放射治疗后复发的外科补救治疗

Salvage Surgery for Nasopharyngeal Carcinoma After Irradiation Failure

目的:探讨鼻咽癌放射治疗失败后的手术补救治疗,进一步提高鼻咽癌患者的生存质量和远期生存率。方法:对我科经手术治疗的鼻咽癌放射治疗未控或放射治疗后复发者26例(鼻咽病变13例,颈部病变6例,鼻腔病变4例,耳部病变3例)进行了回顾性分析总结。患者术前接受的放射治疗量为60-70 Gy,部分病人还进行化疗。手术方案:①鼻咽原发灶手术。鼻窦内窥镜下使用鼻窦切割钻、半导体激光、专用双极电凝等进行局部切除;②颈部手术。根据淋巴结转移情况分别进行根治性、改良根治性和选择性颈淋巴结清扫术。③鼻部手术。鼻侧切开+上颌骨部分切除术。④耳部手术。耳后切口扩大乳突根治术。全部患者术后进行了40-50 Gy的补充放疗并进行了2-10年的随访。结果:手术并发症发生率为15.4%(4/26)。术后2年患者均存活。结论:鼻咽癌首选放射治疗,首次放射治疗失败后可进行手术补救,术后可再次放射治疗,有望提高生存率和生活质量。

Objective： To study the salvage surgery for nasopharyngeal carcinoma after irradiation failure. Methods： Twenty-six full-dose-irradiation-uncontrolled cases of nasopharyngeal carcinoma had undergone salvage surgery during 1995 to 2005, in which 13 had primary lesion, 6 had neck lesion, 4 had noselesion and had 3 ear lesion. All patients received radiation before surgery with the dose of 60-70 Gy. Semiconductor laser and endoscopic surgery were used for excision of tumour in the primary site. Radical or selective neck dissection was used to remove the cervical lymph node involved. The lateral rhinotomy and partial maxillectomy were used for cases with remnant at the nasal cavity. The extensive radical mastoidectomy was used for cases with remnant at the ear. All patients received supplemental radiation after surgery with the dose of 40-50 Gy and were followed up for 2-10 years. Results： The complication rate after surgery was 15% （4/26）. There were no patients died within two years after operation. Conclusion： It suggests that the surgery should be considered as salvage procedure for the cases of nasopharyngeal cancer after irradiation failure and irradiation could be used after operation.