Nicolai Piero, Battaglia Paolo, Bignami Maurizio, Bolzoni Villaret Andrea, Delù Giovanni, Khrais Tarek, Lombardi Davide, Castelnuovo Paolo
Department of Otorhinolaryngology, University of Brescia, Brescia, Italy.
Am J Rhinol. 2008 May-Jun;22(3):308-16. doi: 10.2500/ajr.2008.22.3170.
The increasing expertise in the field of transnasal endoscopic surgery recently has expanded its indications to include the management of sinonasal malignancies. We report our experience with the endoscopic management of nasoethmoidal malignancies possibly involving the adjacent skull base.
A retrospective analysis was performed of patients treated by an exclusive endoscopic approach (EEA) or a cranioendoscopic approach (CEA) from 1996 to 2006 managed by two surgical teams at the Departments of Otorhinolaryngology of the University of Brescia, and the University of Pavia/Insubria-Varese, Italy.
One-hundred eighty-four patients were considered eligible for the present analysis. An EEA was performed in 134 patients and the remaining 50 patients underwent the CEA. The most frequent histotypes encountered were adenocarcinoma (37%), squamous cell carcinoma (13.6%), olfactory neuroblastoma (12%), mucosal melanoma (9.2%), and adenoid cystic carcinoma (7.1%). Overall, 86 (46.7%) patients received some form of adjuvant treatment. The patients were followed up for a mean of 34.1 months (range, 2-123 months). The 5-year disease-specific survival was 91.4 +/- 3.9% and 58.8 +/- 8.6% (p = 0.0004) for the EEA and CEA group, respectively.
To the best of our knowledge, this is the largest series reported to date of malignant tumors of the sinonasal tract and adjacent skull base treated with pure endoscopic or cranioendoscopic techniques. A 5-year disease-specific survival of 91.4% and 58.8% for the EEA and the CEA groups, respectively, seem to indicate that endoscopic surgery, when properly planned and in expert hands, may be a valid alternative to standard surgical approaches for the management of malignancies of the sinonasal tract.
近年来，经鼻内镜手术领域专业技术的不断提高，已将其适应证扩展至鼻窦恶性肿瘤的治疗。我们报告了内镜治疗可能累及相邻颅底的鼻筛窦恶性肿瘤的经验。
对1996年至2006年间由意大利布雷西亚大学和帕维亚大学/因苏布里亚 - 瓦雷泽大学耳鼻喉科的两个手术团队采用单纯内镜入路（EEA）或颅面内镜入路（CEA）治疗的患者进行回顾性分析。
184例患者被认为符合本分析标准。134例患者采用EEA治疗，其余50例患者接受CEA治疗。最常见的组织学类型为腺癌（37%）、鳞状细胞癌（13.6%）、嗅神经母细胞瘤（12%）、黏膜黑色素瘤（9.2%）和腺样囊性癌（7.1%）。总体而言，86例（46.7%）患者接受了某种形式的辅助治疗。患者平均随访34.1个月（范围2 - 123个月）。EEA组和CEA组的5年疾病特异性生存率分别为91.4±3.9%和58.8±8.6%（p = 0.0004）。
据我们所知，这是迄今为止报道的采用单纯内镜或颅面内镜技术治疗鼻窦和相邻颅底恶性肿瘤的最大系列病例。EEA组和CEA组的5年疾病特异性生存率分别为91.4%和58.8%，这似乎表明，当计划得当且由专家操作时，内镜手术可能是治疗鼻窦恶性肿瘤的标准手术方法的有效替代方案。
