Zhang Yan-Ping, Lin Lin, Gong Lian-Fang, Huang De-Liang
Department of Otorhinolarynology Head and Neck Surgery, Chinese PLA General Hospital, Beijing 100853, China.
Zhonghua Er Bi Yan Hou Ke Za Zhi. 2004 Jun;39(6):333-6.
To investigate the symptoms, factors relating to recurrences, the styles of the rescue operation and the reconstructive methods of the surgical defects in patients with recurrent nasal and paranasal sinus neoplasms.
Excluding the primary neoplasm, only patients with recurrent tumors and suitable for rescue operations entered the group. Kaplan-Meier method was used to estimate the survival probability.
Twenty-five patients receiving rescue operations from 1993 to 2002 who met the above inclusion criteria were reviewed. The age ranged from 13 - 66 years. All the patients had once surgery or radiation therapy at least. The time between the last treatments and the recurrences ranged from 2 weeks to 46 months. 80 per cent of the recurrences were within the first 2 years after the last therapy. The recurrent symptoms included headache (10 patients), eminences in or around the operation fields (9 patients), diminution of vision (7 patients), and so on. The patients were followed 1 to 65 months. There were no patients died during the rescue operations. Five patients were alive without recurrences and 3 alive with local or regional recurrences. Thirteen died of local recurrences and 1 died of metastasis to lung. The one-year, 2-year and 3-year survival rate were 62.5%, 43.7% and 29.1%, respectively. The median survival time was 18 months. Complications included cerebrospinal rhinorrhea (3 patients), central diabetes insipidus (1 patient) and necrosis of part of the flap (1 patient).
Most of the local recurrences occur within 2 years after the last therapies. The recurrent symptoms are commonly headache and eminences in or around the operation fields. The recurrences are closely related to pathological types and differential degrees of the neoplasms. The reasonable and timely combined treatment may help to decrease the frequencies of the recurrences. The rescue operations with effective methods can improved the patients' life qualities and lengthen their life spans. The main complications are cerebrospinal rhinorrhea most of which can be cured by conservative treatment.
探讨复发性鼻腔鼻窦肿瘤患者的症状、复发相关因素、挽救性手术方式及手术缺损的修复方法。
排除原发性肿瘤，仅将复发性肿瘤且适合挽救性手术的患者纳入本研究组。采用Kaplan-Meier法估计生存概率。
回顾性分析1993年至2002年期间接受挽救性手术且符合上述纳入标准的25例患者。年龄范围为13至66岁。所有患者均至少接受过一次手术或放疗。上次治疗与复发之间的时间间隔为2周至46个月。80%的复发发生在最后一次治疗后的前2年内。复发症状包括头痛（10例）、术野内或术野周围隆起（9例）、视力减退（7例）等。对患者进行了1至65个月的随访。挽救性手术期间无患者死亡。5例患者存活且无复发，3例存活但有局部或区域复发。13例死于局部复发，1例死于肺转移。1年、2年和3年生存率分别为62.5%、43.7%和29.1%。中位生存时间为18个月。并发症包括脑脊液鼻漏（3例）、中枢性尿崩症（1例）和部分皮瓣坏死（1例）。
大多数局部复发发生在最后一次治疗后的2年内。复发症状常见为头痛和术野内或术野周围隆起。复发与肿瘤的病理类型和分化程度密切相关。合理及时的综合治疗可能有助于降低复发频率。采用有效方法的挽救性手术可提高患者生活质量并延长其寿命。主要并发症是脑脊液鼻漏，其中大多数可通过保守治疗治愈。
