鼻腔鼻窦鳞癌侵犯眼眶时眼球的处理

The Treatment of the Eyeball in Nasal Squamous Cell Carcinoma Invading the Orbit

目的探讨鼻腔鼻窦鳞状细胞癌侵犯眼眶时保留或剜除眼球对生存率和复发率的影响。方法回顾性分析1989年1月～1998年2月我院收治的43例侵犯眶骨壁和眶骨膜的鼻腔、鼻窦鳞状细胞癌患者的临床和随访资料,其中25例剜除眼球,18例保留眼球。比较患者的3年生存率和复发率。结果随访38～126个月,43例患者中,眼球剜除组3年生存率为56%(14/25),局部复发率为36%(9/25),保留眼球组3年生存率为55.5%(10/18),局部复发率为38.8%(7/18),其中1例为眶内复发。结论经术前或术后放疗,对侵犯眶骨壁和眶骨膜的鼻腔、鼻窦鳞癌,保留眼球组与剜除眼球组相比:有相似的局部复发率和生存率,但保留眼球提高了术后生活质量。

Purpose To explore the influence of local recurrence or survival rate by using ocular reserving surgery for the treatment of squamous cell carcinoma (SCC) of nasal cavity and paranasal sinuses. Methods Forty-three patients with SCC of nasal cavity and sinonasal tract invading the orbital bones, treated primarily at our department from January 1989 to December 1998 were retrospectively analysed. The recurrence rate and survival rate after 3 years of twenty-five patients with exenteration of the orbital contents, and eighteen patients with reserving of eyeball were compared. Results After 38 to 126 month's follow-up,56% of the patients whose orbital contents was exenterated were alive and the rate of local recurrence was 36%, compared with 55.5% and 38% respectively of the patients whose eyeballs were reserved except 1 patient who recurred in orbit. The differences were not statistically significant (P > 0.05) . Conclusion The study demonstrates that reserving of eyeball when the orbit has been invaded by SCC does not downgrade the rate of local control or survival, but, on the contrary, improve the patient s quality of life.