内镜下复发性鼻咽癌外科治疗创新体系建设

鼻咽癌是我国常见恶性肿瘤，放疗是初发鼻咽癌的首选治疗方案。经过放疗后仍有5%~15%的患者出现疾病复发。再次放疗难以取得满意的疗效，同时发生严重放疗后并发症的风险较高，所以复发性鼻咽癌患者推荐经鼻内镜入路的挽救性手术治疗。相比再次放疗，内镜手术可以更好地延长患者生存时间、改善生活质量、减少治疗后并发症的发生以及患者总体医疗费用，然而鼻咽颅底解剖的复杂性增加了内镜手术切除病变的难度和风险。如何提高患者的生存时间是鼻颅底外科医生面临的重要问题，这需要基于解剖的深入研究、颈内动脉的充分评估、手术分型的积极探索、重建方式的合理应用，以及多学科合作，建立鼻咽癌外科诊疗的创新体系。

Establishment of Endoscopic Surgical Innovative System of Recurrent Nasopharyngeal Carcinoma

Nasopharyngeal carcinoma (NPC) is a common malignant tumor in China. Radiotherapy is the firstline treatment. After appropriate radiotherapy, about 5%-15% patients experience recurrence. In view of the poor efficacy and high incidence of severe late toxicities associated with re-irradiation, salvage surgery by the transnasal endoscopic approach is recommended for recurrent NPC (rNPC). Compared with reirradiation, endoscopic surgery can better prolong survival, improve the quality of life, and reduce complications and medical expenses of patients with rNPC. However, the complexity of the nasopharyngeal skull base enhances the difficulty and risk of surgery. Expanding the boundary of surgical resection remains a clinical challenge for otolaryngologists. In this regard, to help more advanced patients with rNPC, the surgical innovative system of NPC needs to be established by multi-disciplinary cooperation, involving skull base anatomy-based investigation, appropriate administration of the internal carotid artery (ICA), repair of skull base defect, and establishment of various types of endoscopic endonasal nasopharyngectomy.