鼻咽癌残留或复发外科挽救治疗的术式选择

目的 :探讨提高鼻咽癌放疗后残留或复发外科挽救治疗效果的手术方式。方法 :对经手术治疗鼻咽低分化鳞癌放疗后鼻咽部残留或复发患者 ,采取颈颌腭下颌骨翻转或上颌骨翻开及经口硬腭等手术入路切除复发病变 ;采用帽状腱膜瓣及胸大肌皮瓣进行术腔的修复和保护。结果 :手术并发症发生率为 16 % ,主要为局部感染或修复组织瓣坏死 ,术后后遗症较轻 ,腭鼻漏 4例 ,除 1例出现咬合错位外 ,其他病例功能及外观均得到满意的恢复。随诊达 3年以上 18例中死亡 8例 ,2例失访。结论 :根据复发肿瘤累及的部位及范围 ,选择最好的手术进路 ,争取相对彻底、安全地清除病变 ;同时采用方便可靠的修复办法 ,保护咽旁颅底重要结构 ,可以进一步提高手术治疗效果

Effect of salvagy surgeries for nasopharyngeal carcinoma

Objective:To explore a reasonable surgical method for improving salvagy surgery of nasopharyngeal carcinoma (NPC).Method:25 cases of nasopharyngeal carcinoma with salvagy surgery were reuiewed. Surgical accesses include the transcervico mandibuio palatal, the maxillary swing approach, the transpalatal approach for removing nasopharyngeal lesion. The pectoralis major muscle flap and galea aponeurotica flap were employed to repair operative defect and protect the critical structure of parapharyngeal space and the skull base.Result:The operative complication rate is 16% (4/25), which are local infection and flap putrescence.The postoperative sequela such as cleft palate is slight. 18 cases were followed up over 3 year and 8 cases died. 2 cases were losd.The 3 year survival rate is 44%(8/18).Conclusion:The best operation access should be selected depending on the position and the implicated scope. Safely and fully removal of the tumor and reliably reconstruct are ncessary. It is possible to improve salvage surgery effect for NPC patients.