Choi Eun Chang, Choi Yoon-Seok, Kim Chang-Hoon, Kim Kyubo, Kim Kyung-Su, Lee Jeung-Gweon, Kim Gwi Eon, Yoon Joo-Heon
Department of Otorhinolaryngology, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea.
Yonsei Med J. 2004 Aug 31;45(4):621-8. doi: 10.3349/ymj.2004.45.4.621.
We investigated the surgical outcome of radical maxillectomy in advanced maxillary sinus cancers invading through the posterior wall and into the infratemporal fossa. Twenty-eight patients with maxillary sinus squamous cell carcinoma, who visited the Otorhinolaryngology Department at Severance Hospital from March, 1993 to February, 2001 and underwent the surgery, were analyzed retrospectively by reviewing clinical medical records and radiologic test results. The mean follow- up period was 78.8 months.(26-162 months) Local recurrence, sites of local recurrence, and the 2-year disease-free survival rate were analyzed. Of the total 28 cases, 9 cases were T3, and 19 cases were T4. Total maxillectomy was performed in 12 cases (42.9%) and radical maxillectomy in 16 cases (57.1%). Regardless of staging, radical maxillectomy was performed only when cancers invaded through the posterior wall and into the infratemporal fossa. When cancers only maginally or did not invade the posterior wall, total maxillectomy was performed. The 2-year disease-free survival rate was 75% for both total and radical maxillectomy, and the local recurrence rates were 8.3% and 18.7% respectively. All recurrence occurred at the posterior resection margin of the maxillectomy. We strongly recommend the use of radical maxillectomy in the cases of advanced maxillary sinus cancers invading the infratemporal fossa. Radical maxillectomy can provide sufficient safety margins and lower the local recurrence rate.
我们研究了晚期上颌窦癌侵犯后壁并累及颞下窝时行根治性上颌骨切除术的手术效果。对1993年3月至2001年2月期间就诊于首尔延世大学Severance医院耳鼻喉科并接受手术的28例上颌窦鳞状细胞癌患者，通过回顾临床病历和放射学检查结果进行了回顾性分析。平均随访期为78.8个月（26 - 162个月）。分析了局部复发情况、局部复发部位以及2年无病生存率。28例患者中，9例为T3期，19例为T4期。12例（42.9%）行全上颌骨切除术，16例（57.1%）行根治性上颌骨切除术。无论分期如何，仅当癌症侵犯后壁并累及颞下窝时才进行根治性上颌骨切除术。当癌症仅边缘性侵犯或未侵犯后壁时，行全上颌骨切除术。全上颌骨切除术和根治性上颌骨切除术的2年无病生存率均为75%，局部复发率分别为8.3%和18.7%。所有复发均发生在上颌骨切除术后的后切缘。对于侵犯颞下窝的晚期上颌窦癌病例，我们强烈建议采用根治性上颌骨切除术。根治性上颌骨切除术可提供足够的安全切缘并降低局部复发率。
