经鼻内镜鼻咽切除及带血管蒂鼻腔粘膜瓣修复术【精品-】.pptVIP

陈明远 博士, 副教授 经鼻内镜鼻咽切除及带血管蒂鼻腔粘膜瓣修复术 治疗T1/T2a和选择后T2b/T3鼻咽恶性肿瘤 中山大学肿瘤防治中心鼻咽癌科 广州市东风东路651号 Email: chenmy@mail.sysucc.org.cn 研究背景 鼻咽癌首选放射治疗，放疗后单纯局部复发率约10%； 救援性外科治疗是局部复发鼻咽癌最佳治疗手段之一； 鼻咽切除术也是鼻咽腺癌、肉瘤等的治疗方法之一； 鼻外进路：空间大但创伤大 鼻内进路：微创但空间狭窄 ？ Endoscopic surgery Oncological Endoscopic nasopharyngectomy Conventional open surgery 经鼻内镜鼻咽切除术 rNPC, T2bN0M0 Pre- Op Post- Op 手术前后MRI对比 手术前后MRI对比 结果 1 N=67 Male: female 15 male 52 Radiotherapy: one circle 53 two circles 14 rT stages (UICC2002): rT1 27 rT2a 7 rT2b 22 rT3 11 Median age, years (range) 49(27~71) From Oct 2004 to Jan 2010 with median follow-up 28 months (4~68 m) From Oct 2004 to June 2009 with median follow-up 31 months (6~68 m) 生存曲线 Surgical approach n Op time (min) Blood loss (ml) Post-op hospital stay (d) Ectro-pion Nerve tran-section Palatal fistula trismus Impaired swallow-ing Nasal regurg-itation Others Chen MY1 Transnasal with endoscopy 37 195 117 5 0 0 0 - 0 0 8a Willard EF2 Tanspalatal Transcervic Transmaxilla 15 270 1072 7.9 - 3 - - 1 - 4 37 300 981 6 4 5 10 To EW3 Transnasal with SNG 15 185 917 11 0 0 0 0 1 2 Maxilla swing 12 240 1398 32 9 6 3 4 2 5 3 Mandibular swing 5 387 1596 54 0 3 1 2 1 1 maxilla and mandibular 3 585 1270 63 2 2 0 3 2 1 a: secretory otitis media Chen MY, et al. Endoscopic nasopharyngectomy for locally recurrent nasopharyngeal carcinoma. Laryngoscope 2009; 119(3):516-522 Willard EF, et al. Nasopharyngectomy for recurrent nasopharyngeal cancer: a 2- to 17-year follow-up[J]. Arch-Otolaryngol-Head-Neck-Surg, 2002,128(3): 280-284. To EW , et al. The use of stereotactic navigation guidance in minimally invasive transnasal nasopharyngectomy: a comparison with the conventional open transfacial approach[J]. Br-J-Radiol,2002, 75(892): 345-350. 与鼻外进路鼻咽切除术的对比 Group 1（N=18） Group 2（N=18） P Value Gender: female 3 4 male 15 14 0.317 rT stages (UICC2002): rT1 9 9 rT2a 1 1 rT2b 8 8 1.0 Radiotherapy: one circle