嗅神经母细胞瘤鼻内镜治疗探讨

目的探讨经鼻内镜手术治疗嗅神经母细胞瘤的可行性及疗效。方法回顾性分析我院2003年1月~2007年12月间收治的9例嗅神经母细胞瘤患者临床资料,按Kadish改良分期为A期1例,B期5例,C期2例,D期1例,均行鼻内镜下肿瘤切除术,术后接受放疗和化疗。结果全组病例术后无颅内感染、脑脊液鼻漏、视力受损等并发症。9例均获随访,平均随访时间79(56~112)个月。共4例患者复发:1例B期患者首次治疗后2年内出现鼻腔鼻窦复发,再次行鼻内镜肿瘤切除术、颈淋巴清扫术,术后化疗和放疗,1年后死于颅内复发;1例C期患者于1年后死于颅内复发,另1例C期在术后4年死于颅内复发和感染;D期的1例患者2年后死于肺部和骨复发。本组病例3年生存率为66.7%(6/9),5年生存率为55.6%(5/9)。结论鼻内镜下肿瘤切除术对临床A、B期嗅神经母细胞瘤是一种有效治疗方法,对晚期病人应行颅面或颅鼻径路鼻内镜辅助下肿瘤切除术。

Endoscopic Sinus Surgery of Olfactory Neuroblastoma

Objective To explore the feasibility and therapeutic efficacy of transnasal endoscopic resec- tion for olfactory neuroblastoma. Methods A total of 9 patients with olfactory neuroblastoma admitted from January 2003 to December 2007 were analyzed retrospectively, including 1 cases of stage A, 5 cases of stage B, 2 cases of stage C and 1 case of stage D according to the modified Kadish clinical staging. All cases were per- formed tumor resection under nasal endoscope and following radiotherapy and chemotherapy. Results There was no complication such as intracranial infection, cerebrospinal fluid rhinorrhea and visual impairment. All 9 cases were followed up for 56 to 112 months with an average of 79 months. Four cases were found local rescur- rence： One case with stage B recurred in nasal cavity and paranasal sinuses 2 years after the operation and re- ceived reoperation, chemo- and radio-therapy, then died of intracalvarium recurrence 1 year after the reopera- tion; Two cases with stage C was died of intracalvarium recurrence 1 year after the operation and intracalvarium relapse and infection 4 years after the operation respectively; One case with stage D was died of recurrence in lung and bone 2 years after the operation. The 3-year survival rate was 66.7% （6/9） and the 5-year survival rate was 55.6% （5/9）. Conclusion The tumorectomy via endoscopic sinus surgery is an effective method for the olfactory neuroblastoma patients with stage A and B, however the tumorectomy via transnasal endoscope approach combined with craniotomy should be recommended for the advanced patients with stage C and D.