鼻咽癌内镜手术治疗临床分析

Clinical analysis of endoscopic surgery for nasopharyngeal carcinoma

目的探讨鼻内镜手术在鼻咽癌治疗中的应用及临床疗效。方法回顾性分析2010年1月至2018年6月青岛大学附属医院耳鼻咽喉头颈外科、鼻颅底外科收治的35例鼻咽癌患者的临床资料。其中男21例,女14例,年龄最大者75岁,年龄最小者17岁,中位年龄52岁。病例首诊时主要症状为鼻塞5例,涕中带血13例,耳闷、听力下降4例,颈部肿物5例,咽部不适3例,头痛、复视5例。TNM分期:Ⅰ期5例,Ⅱ期12例,Ⅲ期12例,Ⅳ期6例;T分期:T_1期7例,T_2期13例,T_3期9例,T_4期6例;N_X 2例,N_0 16例,N_1 9例,N_2 7例,N_3 1例;M分级均为0级,均未出现远处转移情况。患者均接受内镜下鼻咽颅底肿瘤切除术,术后予以放疗或同期化疗。随访后结果采用SPSS 22.0软件分析,生存曲线采用Kaplan-Meier法绘制,生存曲线比较采用Log-rank法。结果 35例患者的病理类型为非角化性癌未分化型22例;非角化性癌分化型5例,鳞状细胞癌8例。随访3～95个月,其中3例(8.6%)出现复发,31例(88.6%)存活,4例(11.4%)死亡,其中2例死于肿瘤远处转移,1例死于颈内动脉大出血,1例死于肿瘤局部复发并侵犯颅底或颅内。1、2、3年的生存率分别为95.23%、95.23%和87.91%。结论鼻内镜手术治疗鼻咽癌有利于鼻咽癌患者的远期预后效应。

Objective To explore the clinical efficacy in patients who underwent endoscopic nasopharyngectomy for primary advanced nasopharyngeal carcinoma (NPC). Methods Clinical data of 35 patients with NPC admitted to the Department of Otorhinolaryngology Head and Neck Surgery and Nasal Skull Base Surgery of the Affiliated Hospital of Qingdao University from January 2010 to June 2018 were retrospectively reviewed. Twenty-one patients were male, and 14 were female. The median age was 52 years (range, 17-75 years). There were five cases of nasal obstruction, 13 cases of snot with blood, 4 cases of hearing loss and stuffy ear, 5 cases of neck mass, 3 cases of pharyngeal discomfort, and 5 cases of headache and diplopia. The TNM stages were: 5 cases were at stage Ⅰ, 12 cases were at stage Ⅱ, 12 cases were at stage Ⅲ, and 6 cases were at stage Ⅳ. Nx 2 cases, N0 16 cases N19 cases, N2 7cases, N3 1 case. No patient was found to have distant metastasis. All patients underwent endoscopic resection of the lesions. Postoperatively, all patients were treated with radiotherapy or chemoradiotherapy. Using SPSS 22.0 software, Kaplan-Meier analysis and Log-rank test were done for the assessment of survival rate. Results The pathological types of the 35 patients were as follows: 22 patients had undifferentiated type of non-keratinized carcinoma, 5 patients had non-keratinized differentiated carcinoma, and 8 patients had squamous-cell carcinoma. The follow-up ranged from 3 to 95 months, with relapse observed in 3 cases (10.0%), survival in 31 cases (82.5%), and death in 4 cases (17.5%). The overall 1 year survival rate (SR), 3 year SR, 5 year SR were 95.23%, 95.23%, and 87.91%, respectively. Conclusion Patients who undergo endoscopic nasopharyngectomy for NPC have better long-term prognosis.