鼻中隔恶性肿瘤鼻内镜下手术深浅层次初探

Preliminary approach of deep and superficial layer under intranasal endoscope operation for nasal septum malignant tumour

目的:初步探讨鼻中隔恶性肿瘤在鼻内镜下手术深浅层次问题。方法:将19例适应鼻内镜下手术的鼻中隔恶性肿瘤患者,根据肿瘤的大小、部位、浸润程度、手术过程探查情况分3组进行治疗。第1组(6例)实施第1层次手术治疗,第2组(9例)实施第2层次手术与部分患者加放疗,第3组(4例)实施第3层次手术与全部患者加放疗。结果:第1组中无瘤生存4例,局部复发2例;第2组中无瘤生存5例,局部复发2例,局部转移1例,死亡1例;第3组中无瘤生存2例,局部复发1例,局部转移1例。3组之间的疗效比较差异无统计学意义(P>0.05)。所有患者5年生存率为94.7%,5年无瘤生存率为57.9%。结论:鼻中隔恶性肿瘤鼻内镜下手术有一定的适应证,手术深浅层次的选择与手术安全缘的掌握具有同等重要的临床意义。

Objective：To preliminary discuss the questions of deep and superficial layer under intranasal endoscope operation for nasal septum malignant tumour.Method：The patients of 19 cases with nasal septum malignant tumour who adapt to the operation under intranasal endoscope were divided into 3 groups and were treated separately according to the range,position,infiltrative degree of tumour and exploring conditions in operative process.The treatments of first group had executed with first layer operation.The second group had executed with second layer operation in addition partial patients radiotherapy.The third group had executed with third layer operation in addition total patients radiotherapy.Result：The tumour-free survivals have 4 cases and local recurrences have 2 cases in 6 cases of first group.The tumour-free survivals have 5 cases,local recurrence has 2 cases,local metastasis has 1 cases and death has1 case in 9 cases of second group.The tumour-free survivals have 2 cases,local recurrence has 1case and local metastasis has 1 case in 4 cases of third group.The treated effects have not statistical differences in 3 groups（P〉0.05）.Five-year survival rate was 84.2% and five-year tumour-free survival rate was 57.9% for all patients.Conclusion：The operations under intranasal endoscope for nasal septum malignant tumour have certainly indication.The selection of operative deep and superficial layer and control of operative safety margin have the same important clinical signification.