Teichgraeber J F, Goepfert H
Department of Plastic Surgery, University of Texas Medical School, Houston.
Otolaryngol Head Neck Surg. 1990 Apr;102(4):362-9. doi: 10.1177/019459989010200410.
Cancer of the nasal skin is usually well-circumscribed, superficial, and has an excellent prognosis. However, a small number of aggressive lesions require a partial or total rhinectomy. We retrospectively reviewed patients seen at the M.D. Anderson Cancer Center between January 1, 1970, and December 31, 1980, for nasal cancer. There were 147 patients identified as requiring full-thickness nasal resections, of whom 68 (46.3%) required a hemi- or complete rhinectomy. Lesions requiring extensive rhinectomy usually involved the ala or were recurrent multicentric, squamous cell carcinomas greater than 4 cm. These patients had significantly poorer prognoses than the group in general. Recurrence developed in 45 patients (30.6%), and two thirds of all recurrences were seen within 2 years. In this series, the histology of the malignancy and its size, in the case of large basal cell carcinomas, were both predictive of a poor prognosis. Only the primary site was significant in predicting recurrence, whereas tumor size and histology were significant predictors of the need for an extensive rhinectomy. Delayed reconstruction is recommended in patients who are in poor health and have large recurrent lesions that are multicentric or involve the ala or dorsum. The timing of reconstruction is individualized, but a 2-year wait after surgery is recommended. Prosthetic rehabilitation is a good interim measure.
鼻皮肤癌通常边界清晰、表浅，预后良好。然而，少数侵袭性病变需要进行部分或全鼻切除术。我们回顾性分析了1970年1月1日至1980年12月31日期间在MD安德森癌症中心就诊的鼻癌患者。共有147例患者被确定需要进行全层鼻切除，其中68例（46.3%）需要进行半鼻或全鼻切除术。需要广泛鼻切除术的病变通常累及鼻翼或为复发性多中心鳞状细胞癌，直径大于4厘米。这些患者的预后明显比总体人群差。45例患者（30.6%）出现复发，所有复发中有三分之二在2年内出现。在本系列研究中，恶性肿瘤的组织学类型及其大小（对于大的基底细胞癌而言）均预示预后不良。仅原发部位对预测复发有意义，而肿瘤大小和组织学类型是需要进行广泛鼻切除术的重要预测因素。对于健康状况较差且有大的复发性病变、多中心病变或累及鼻翼或鼻背的患者，建议延迟重建。重建时机应个体化，但建议术后等待2年。假体修复是一种很好的临时措施。
