Zhang Weitian, Guo Jinbao, Yin Shankai
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2012 Jun;26(12):572-6.
Nasopharyngeal cancer is a low differentiated squamous cell carcinoma, and the radiation therapy is the primary choice. It's 5 year survival rate may reach 64.4%, while 10.0% cases may suffer from the local recurrence. The salvage radiation or surgery is still the main choice for recurrent cases now. However the recurrent tumor become radiation insensitive and meanwhile, morbidity and mortality become higher. The experience of open salvage surgery on the recurrent radiation insensitive tumor had been proved safely, and the related morbidity and mortality are acceptable. Recently, the endoscopic salvage surgery has been developed, some preliminary experience has been obtained and the result looks promising. In this article, the pathobiological characteristics of the postradiation local recurrent nasopharyngeal cancer, the anatomy of nasopharyngus and related skull base area, especially the petroclival region and current situation of endonasal endoscopic salvage surgery were reviewed here. Basic principle of oncological surgery that endoscopic surgery should followed and possible endoscopic surgical approaches were proposed.
鼻咽癌是一种低分化鳞状细胞癌,放射治疗是主要的治疗选择。其5年生存率可达64.4%,而10.0%的病例可能会出现局部复发。挽救性放疗或手术仍是目前复发病例的主要选择。然而,复发性肿瘤对放疗不敏感,同时发病率和死亡率更高。对复发性放疗不敏感肿瘤进行开放性挽救手术的经验已被证明是安全的,相关的发病率和死亡率是可以接受的。近年来,内镜挽救手术得到了发展,已获得一些初步经验,结果看起来很有前景。本文回顾了放疗后局部复发性鼻咽癌的病理生物学特征、鼻咽及相关颅底区域的解剖结构,特别是岩斜区以及鼻内镜挽救手术的现状。提出了内镜手术应遵循的肿瘤外科基本原则以及可能的内镜手术入路。