嗅神经母细胞瘤手术方法的探讨

Investigation of surgical managements of olfactory neuroblastoma

目的探讨嗅神经母细胞瘤手术方式的选择及治疗效果。方法本文回顾性分析1987年8月—2006年12月我院收治的32例嗅神经母细胞瘤患者，对其手术方式及术后治疗与疗效进行了对比研究。结果随访时间8～135个月，中位随访时间20个月。鼻内镜手术者随访时间为8～79个月，内镜经鼻联合经颅入路者随访时间为10～87个月。应用Kaplan-Meier法按分期对不同的手术入路分别计算生存率，内镜经鼻入路或联合经颅入路患者B期3年生存率78．8％，C期3年生存率50．0％。而鼻侧切开联合经颅入路，B期3年生存率60．0％，C期3年生存率44．4％。两组手术中位出血量有明显差别，分别为140ml（内镜经鼻联合经颅入路组），450ml（鼻侧切开联合经颅入路组），住院时间明显缩短（P〈0．01）。结论鼻腔、鼻窦嗅母细胞瘤A期和B期患者内镜经鼻手术入路和鼻侧切开手术入路的疗效相同，C期内镜经鼻及内镜经鼻联合经颅入路肿瘤切除有较好的疗效。内镜经鼻入路切除嗅神经母细胞瘤是安全有效的，能有效地减少住院时间和手术创伤。

Objective To evaluate the safety and efficacy of transnasal endoscopic resection and craniofacial resection through an external approach for olfactory neuroblastoma（ONB）. Methods Thirty two patients with ONB treated between 1987 and 2006 were retrospectively reviewed. Results The patients were followed up for 8 - 135 months, the median follow-up time was 20 months. The longest followe- up time of patients treated by endoscope was 79 months, and patients treated by combined endoscope and transcranial surgery was 87 months. At Kadish stage B the 3-year survival rate of patients with transnasal endoscopic resection was 78. 8% and at Kadish stage C it was 50. 0%. At Kadish stage B the 3-year survival rate of patients with craniofacial resection through an external approach was 60. 0% and at Kadish stage C it was 44.4%. The bleeding amounts in above two approaches were 140 ml and 450 ml. The average length of stay in hospital in ransnasal endoscopic resection approach was markedly reduced （ P 〈 0. 01 ）. Conclusions Olfactory neuroblastoma can be safely and effectively excised and reconstructed endoscopically with comparable degrees of tissue removal as with external approaches. The time of stay in hospital can be reduced and the surgical trauma can be diminished.