内镜经口入路岩斜区、颈静脉孔区鼻咽癌切除术

Endoscopic transoral approach nasopharyngectomy for petroclival and jugular foramen nasopharyngeal carcinoma

目的探索内镜经口入路的解剖要点及其在岩斜区和颈静脉孔区复发性鼻咽癌(nasopharyngeal carcinoma, NPC)手术中的应用。方法使用3个干性头颅骨性标本和5个新鲜冰冻尸头标本, 采用经口入路显露岩斜区和颈静脉孔区, 记录重要解剖标志及显露范围, 详细介绍该入路的手术方法和技巧。回顾性分析于2020年6月至2022年4月就诊于复旦大学附属眼耳鼻喉科医院的复发性NPC患者6例, 男女比例1∶1, 年龄42~69岁, 所有患者均使用该入路行岩斜区和颈静脉孔区复发性NPC切除术。采用描述性方法进行分析。结果解剖研究显示, 内镜经口入路在保留翼内肌和翼外肌的基础上, 可显露咽旁段、岩骨段和斜坡旁段颈内动脉, 可处理颈静脉孔区和岩斜区的病变。临床实践显示, 6例患者均成功行内镜经口入路NPC切除术, 术后增强MRI见肿瘤完整切除, 患者无咀嚼功能障碍。结论内镜经口入路用于岩斜区和颈静脉孔区复发性NPC切除术, 具有安全、微创、可靠的特点, 值得临床推广。

Objective To describe a technique of endoscopic transoral approach nasopharyngectomy for petroclival and jugular foramen nasopharyngeal carcinoma,based on anatomic studies and surgeries.Methods Three dry human skulls and five fresh human cadaver heads were used for anatomic study of a endoscopic transoral approach to expose petroclival and jugular foramen.The anatomical landmarks and the extent of exposure were recorded.Six clinical cases who were treated in Eye&ENT Hospital,Fudan University from June 2020 to April 2022 were used to illustrate the technique and feasibility of this approach and to assess its indications and advantages,including 3 males and 3 females,aged 42 to 69 years old.Descriptive analysis was used in this research.Results On the basis of the preservation of the internal pterygoid muscle and the external pterygoid muscle,this approach could fully expose the parapharyngeal,petrosal and paraclival segment internal carotid arteries,and safely deal with the lesions of jugular foramen and petroclival region.The 6 patients in our study tolerated the procedure well.Postoperative enhanced MRI showed complete resection of the tumor and no postoperative masticatory dysfunction.Conclusion Endoscopic transoral approach is a safe,minimally invasive and effective surgical treatment for petroclival and jugular foramen recurrent nasopharyngeal carcinoma.