带蒂鼻中隔黏膜瓣在内镜手术治疗复发性鼻咽癌中的应用:附39例分析

Application of pedicle nasoseptal flap in endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma:an analysis of 39 cases

目的探究带蒂鼻中隔黏膜瓣在复发性鼻咽癌手术中的治疗效果及影响因素。方法回顾性分析2016年7月至2019年7月在复旦大学附属眼耳鼻喉科医院收治的39例复发性鼻咽癌患者资料,其中男性19例,女性20例,年龄30~75岁。所有患者均于我院行鼻内镜下鼻咽癌切除及带蒂鼻中隔黏膜瓣修补术。分析术前评估、黏膜瓣制备和鼻咽部重建方法,并探讨影响带蒂鼻中隔黏膜瓣存活的因素。组间率的比较采用Fisher精确检验法。结果手术使用同侧黏膜瓣19例、对侧黏膜瓣20例。术后术腔完全上皮化33例、黏膜瓣坏死6例。研究发现放疗程数是影响黏膜瓣存活的重要因素(OR=7.429,95%CI:1.120~49.270,P=0.042),而性别、年龄、切除范围(TEN分型)、颈内动脉切除、术前是否合并骨坏死以及黏膜瓣侧别对黏膜瓣存活均无影响(P值均>0.05)。术后随访24~60个月,其中8例患者局部复发后再次手术,4例患者全身转移带瘤生存,2例患者死亡。结论带蒂鼻中隔黏膜瓣是鼻内镜下复发性鼻咽癌切除的良好修复材料,但对于多程放疗的患者而言效果稍差。

Objective To explore the therapeutic effect and contributing factors of pedicle nasoseptal flap in endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma.Methods Thirty-nine patients with recurrent nasopharyngeal carcinoma admitted to the Eye,Ear,Nose and Throat Hospital of Fudan University from July 2016 to July 2019 were reviewed,with 19 males and 20 females,aging from 30 to 75 years old.All patients underwent endoscopic nasopharyngectomy,followed by reconstruction with the pedicle nasoseptal flap.The methods of preoperative assessment,mucosal flap preparation and nasopharyngeal reconstruction were summarized,and factors affecting the survival of the pedicle nasoseptal flap were discussed.The rates between groups were compared by Fisher′s exact test.Results Ipsilateral mucosal flap was used in 19 cases while contralateral mucosal flap in 20 cases.After the operation,there were 33 cases with complete epithelialization and 6 cases with flap necrosis.Univariate analysis suggested that the number of radiotherapy courses was an important factor affecting the survival of flap(OR=7.429,95%CI:1.120-49.270,P=0.042).However,gender,age,type of transnasal endoscopic nasopharyngectomy,osteonecrosis,side of flap and internal carotid artery resection had no influence on flap survival(all P>0.05).All patients were followed-up for 24 to 60 months.Among them,8 patients had local recurrence and then operated again,4 patients survived with systemic metastases and 2 patients died.Conclusion The pedicle nasoseptal flap is a good material for reconstruction for endoscopic nasopharyngectomy,but it is less effective for patients with multiple course radiotherapy.