Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
J Surg Oncol. 2012 Mar;105(3):261-5. doi: 10.1002/jso.22062.
To determine the rate and the risk factors for sinonasal-cutaneous fistula formation after treatment for sinonasal malignancy.
Between 1991 and 2002, 99 patients with advanced sinonasal malignancy received radiation therapy +/- surgery. Primary site was maxillary sinus in 30, ethmoid sinus in 19, nasal cavity in 32, nasopharynx in 3, and sphenoid sinus in 15 patients. Eighty-two percent of patients had T4 disease. Sixty-eight percent of patients had undergone surgical resection. Median follow-up was 70.6 months.
Eight patients developed ≥ grade 3 sinonasal-cutaneous fistulas at a median time of 3.8 months after radiation. The overall rates of developing ≥ grade 3 fistulas in the entire group at 2 and 5 years were 6% and 10%, respectively. The fistulas were in the medial canthus in seven patients and in the infraorbital region in one patient. Fistulas developed exclusively along the transfacial incision scar and in patients whose tumors extended to the subcutaneous tissues. In univariate analysis, squamous cell carcinoma histology (P ¼ 0.008), ≤ T4a primary tumor category (P ¼ 0.02), and transfacial incision (P ¼ 0.02) were associated with increased risk of fistula formation.
Histologic subtype, T category, and quality of the skin and the underlying supporting tissues after transfacial incision are risk factors for sinonasal-cutaneous fistula formation.
确定治疗鼻腔鼻窦恶性肿瘤后发生鼻-面皮肤瘘的发生率和危险因素。
1991 年至 2002 年间，99 例鼻腔鼻窦恶性肿瘤患者接受了放疗±手术治疗。原发部位上颌窦 30 例，筛窦 19 例，鼻腔 32 例，鼻咽 3 例，蝶窦 15 例。82%的患者为 T4 期病变。68%的患者接受了手术切除。中位随访时间为 70.6 个月。
8 例患者在放疗后 3.8 个月中位时间时发生了≥3 级的鼻-面皮肤瘘。整个组别的患者在 2 年和 5 年时发生≥3 级瘘的总发生率分别为 6%和 10%。瘘口位于内眦 7 例，眶下区 1 例。瘘口仅沿着经面切口的瘢痕发生，并且发生于肿瘤延伸至皮下组织的患者中。单因素分析显示，鳞状细胞癌组织学（P=0.008）、≤T4a 原发肿瘤分类（P=0.02）和经面切口（P=0.02）与瘘管形成的风险增加相关。
组织学亚型、T 分期、经面切口皮肤及其下支持组织的质量是鼻-面皮肤瘘形成的危险因素。
