内镜下或内镜辅助下的鼻腔-鼻窦恶性肿瘤手术

目的　探讨内镜下或内镜辅助下切除鼻腔 鼻窦恶性肿瘤的可行性和手术效果。方法总结 1997年起 ,在内镜下或内镜辅助下施行鼻腔 鼻窦恶性肿瘤手术的 11例患者的临床资料 ,并对部分术后患者进行随访 ,其中 5例手术后随访时间在 3年以上。 5例患者中行鼻中隔鳞状细胞癌 (简称鳞癌 )切除术 1例 ,行筛窦鳞癌切除术 1例 ,行上颌窦腺样囊性癌切除术 1例 ,行嗅神经母细胞瘤切除术 2例。结果　术后随访时间超过 3年的 5例均无局部复发 ,仅 1例嗅神经母细胞瘤术后 2年 8个月出现左侧颈淋巴结转移 ,术后 3年 10个月出现广泛的脑膜侵犯。结论　内镜下或内镜辅助下可以彻底切除经过选择的鼻腔 鼻窦恶性肿瘤 ,优点是创伤小 ,避免了颜面部瘢痕 ,提高了患者的生存质量 ,但还有待于进一步开展大样本、随机分组、长期随访的临床研究

Endoscopic or endoscope-assisted surgery for sinonasal malignancy

Objective To discuss the feasibility and therapeutic efficacy of resection of sinonasal malignant tumours through endoscopic or endoscope-assisted surgery. Methods Since 1997, 11 cases of malignant tumours were resected under endoscope or by endoscope-assisted surgery. Among them, 5 patients were followed-up for more than 3 years, including one case of nasal septum squamous cell carcinoma; one case of ethmoid sinus squamous cell carcinoma; one case of maxillary sinus adenoid cystic carcinoma and two cases of olfactory neuroblastoma.Results In the patients who were followed-up for more than three years, no local recurrence was found. There was only one case of cervical lymph node metastasis found on a patient with olfactory neuroblastoma 2.5 years after resection . Four years after operation, this patient was suspected to have extensive metastasis in meninges, and only palliative treatment was suggested.Conclusions By endoscope or by endoscope-assisted surgery, some of selected sinonasal malignant tumours can be thoroughly resected. The advantages are mini-invasive and avoidance of facial scar so as to improve the quality of life (QOL) of patients. Large amount of cases, random clinical study with lone- term follow-up are still needed to verify the feasibility and efficacy of endoscopic or endoscope-assisted surgery.