鼻内镜或鼻内镜辅助下鼻腔鼻窦恶性肿瘤切除术的初步分析

目的：探讨鼻内镜或鼻内镜辅助下切除鼻腔鼻窦恶性肿瘤的可行性和疗效。方法：回顾性分析我院收治的40例鼻腔鼻窦恶性肿瘤患者的临床资料。病理类型为内翻性乳头状瘤恶变5例，上颌窦癌2例，筛窦癌3例，恶性黑色素瘤11例，嗅神经母细胞瘤7例，神经内分泌癌2例，肌上皮癌4例，鼻腔软骨肉瘤2例，腺样囊性癌3例，恶性血管外皮细胞瘤1例。所有患者均行鼻内镜或鼻内镜辅助下肿瘤切除术，其中32例术后采用放化疗。结果：所有患者随访1～5年，其中22例随访1～3年，随访3年以上者18例。4例患者术后6个月～2年症状复发，再次行鼻内镜手术后疗效满意；3例术后出现颈淋巴结转移，其中2例行颈淋巴结清扫术，1例因无手术指征而行放、化疗；4例出现远处转移；8例死亡；其余21例在随访期间未见复发及转移。结论：鼻内镜或鼻内镜辅助下手术切除鼻腔鼻窦恶性肿瘤切实可行，但必须严格选择适应证，辅以术后综合治疗，可取得满意的疗效。

Primary analysis of endoscopic surgery and endoscopic-assisted surgery for sinonasal malignacy

Objective：To investigate the feasibility and efficacy of endoscopic sinus surgery for sinonasal ma lignacy. Method：Clinical data of 40 cases of sinonasal malignacy treated in our hospital from January 2007 to De- cember 2011 were retrospectively analyzed. The pathological types encountered were：5 cases of mlignant transfor- mation of sinonasal inverted papilloma, 2 cases of maxillary sinus carcinoma, 3 cases of ethmoid sinus carcinoma, 11 cases of mucosal melanoma, 7 cases of olfactory neuroblastoma, 2 cases of neuroendocrine carcinoma, 4 cases of myoepithelial carcinoma,3 cases of adenoid cystic carcinoma, 1 case of malignant hemangiopericytoma. These pa- tients were operated on either by an exclusive endoscopic surgery or endoscopic surgery with a complementary ex- ternal approach. Thirty-two patients received adjuvant radiotherapy and/or chemotherapy. Result： All the patients were followed up for a period of 1 to 5 years after operation,of which 18 cases survived for more than three years. Four cases recurred after six months to two years, but the result was satisfactory after revision endoscopic sinus surgery. Three cases occurred cervical lymph node metastasis,of which 2 cases received neck dissection and 1 case received chemotherapy and radiotherapy due to no surgical indications. Four cases occurred distant metastasis. Eight cases died of tumor until the last follow-up. The other 21 cases occurred no recurrence and metastasis during follow-up period. Conclusion：Endoscopic sinus surgery is an effective method for sinonasal malignacy. Appropriate indication must be carefully selected for malignant tumor. Combined treatment based on surgery should be adopted to it.