带蒂鼻中隔黏膜瓣在复发性鼻咽癌内镜鼻咽切除术中的疗效及危险因素分析

Analysis of curative effect and risk factors of pedicled nasal septum flap in endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma

目的探究带蒂鼻中隔黏膜瓣在复发性鼻咽癌内镜鼻咽切除术中的疗效及危险因素。方法选取2018年5月—2022年5月在郑州大学第一附属医院采用内嵌入路鼻咽切除术(endoscopic nasopharyngectomy,ENPG)诊治的复发性鼻咽癌患者84例,均给予蒂鼻中隔黏膜瓣修补术及ENPG,分析治疗后带蒂鼻中隔黏膜瓣坏死情况及其危险因素。结果随访截止至2023年10月,鼻中隔黏膜瓣坏死13例,坏死率为15.48%,其中7例患者,定期清理坏死组织,最后鼻咽部Ⅱ期愈合,4例患者再行鼻底游离黏膜瓣修复和鼻咽部坏死组织切除,2例局部复发,带瘤生存。将鼻中隔黏膜瓣坏死13例纳入为坏死组,其余纳入为成活组,经单因素分析,坏死组T分期、N分期、放疗疗程、血红蛋白、NK细胞比例与成活组比较,均有统计学意义(P<0.05);经二元logistic回归分析,N分期(N2~N3)、放疗疗程(两程)、血红蛋白(贫血)是鼻中隔黏膜瓣坏死的危险因素,NK细胞比例≥20%是鼻中隔黏膜瓣坏死的保护因素(P<0.05)。结论带蒂鼻中隔黏膜瓣是ENPG治疗复发性鼻咽癌的良好修复材料,但N分期(N2~N3)、放疗疗程(两程)、血红蛋白(贫血)、NK细胞比例<20%的患者效果稍差。

Objective To explore the efficacy and risk factors of pedicled nasal septum flap in endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma.Methods From May 2018 to May 2022,totally 84 patients with recurrent nasopharyngeal carcinoma were treated with ENPG in our hospital.All patients were given pedicled nasal septum flap repair and endoscopic nasopharyngectomy(ENPG),and the necrosis of pedicled nasal septum mucosal flap and its risk factors were analyzed after treatment.Results Up to October,2023,there were 13 cases of nasal septum mucosal flap necrosis,the necrosis rate was 15.48%.Among them,7 cases were cleaned up regularly,and finally the nasopharynx healed in the second stage,4 cases were repaired with free nasal mucosa flap and nasopharyngeal necrotic tissue resection,and 2 cases recurred locally and survived with tumors.Thirteen cases of nasal septum mucosal flap necrosis were included in the necrosis group,and the rest were included in the survival group.By univariate analysis,there were significant differences in T stage,N stage,radiotherapy course,hemoglobin and NK cell ratio between the necrosis group and the survival group(P<0.05).logistic regression analysis showed that N stage(N2-N3),radiotherapy course(two courses)and hemoglobin(anemia)were the risk factors of nasal septum mucosal flap necrosis,and the proportion of NK cells≥20%was the protective factor of nasal septum mucosal flap necrosis(P<0.05).Conclusion The pedicled nasal septum flap is a good repair material for the treatment of recurrent nasopharyngeal carcinoma by ENPG,but the effect of patients with N stage(N2-N3),radiotherapy course(two courses),hemoglobin(anemia)and NK cell ratio<20%is slighly worse.