Wang Z L, Liu J Q, Wei W, Qi Y, Zhang R X, Ren Q Z, Zhang Q H
Department of Otorhinolaryngology Head and Neck Surgery, Skull Base Surgery Center, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Nov 7;57(11):1328-1334. doi: 10.3760/cma.j.cn115330-20220418-00198.
To summarize the clinical experience and treatment results of endoscopic transoral resection of metastatic retropharyngeal lymph nodes (MRPLN) in nasopharyngeal carcinoma (NPC) via posteroinferior eustachian tube approach. The clinical data of 37 patients with NPC who underwent endoscopic transoral surgery via posteroinferior eustachian tube approach for MRPLN in Xuanwu Hospital, Capital Medical University from 2010 to 2020 were analyzed retrospectively. There are 28 males and 9 females, aged from 31 to 72 years. The clinicopathological features such as gender, age, primary tumor stage, stage, side and size of MRPLN were recorded and analyzed. The surgical procedures of endoscopic transoral resection of MRPLN via posteroinferior eustachian tube approach were described. The MRPLN resection, perioperative complications and follow-up results were also summarized. The primary tumors of 37 cases were determined as rT1 stage in 2 cases, rT2 stage in 30 cases and primary T2 stage in 5 cases in this study. There were 33 cases of unilateral MRPLN(89.2%), 4 cases of bilateral ones (10.8%), 36 cases in N1 stage, and 1 case in N3 stage. Single lymph node was detected in 23 cases(62.2%), and 2-5 lymph nodes in 14 cases(37.8%). Endoscopic transoral surgery via posteroinferior eustachian tube approach was completed in all cases. Total MRPLN resection was obtained in 35 cases (94.6%) with one-stage operation, and subtotal resection was achieved in 2 cases whose MRPLN involved the wall of internal carotid artery. No serious complications occurred in the perioperative period. During the follow-up period (median follow-up period 53.1 months), no recurrence of MRPLN was observed in patients who received total resection. And 8 patients (21.6%) died from different causes. Endoscopic transoral surgery via posteroinferior eustachian tube approach for MRPLN is a practicable and effective surgical option, but the long-term effect still needs longer follow-up and summary of bulk cases.
总结经咽鼓管后下途径内镜经口切除鼻咽癌（NPC）咽后转移淋巴结（MRPLN）的临床经验及治疗效果。回顾性分析2010年至2020年在首都医科大学宣武医院经咽鼓管后下途径行内镜经口手术切除MRPLN的37例NPC患者的临床资料。其中男性28例，女性9例，年龄31～72岁。记录并分析患者的性别、年龄、原发肿瘤分期、MRPLN分期、侧别及大小等临床病理特征。描述经咽鼓管后下途径内镜经口切除MRPLN的手术步骤。总结MRPLN切除情况、围手术期并发症及随访结果。本研究中37例患者的原发肿瘤，2例为rT1期，30例为rT2期，5例为原发T2期。单侧MRPLN 33例（89.2%），双侧4例（10.8%）；N1期36例，N3期1例。单枚淋巴结23例（62.2%），2～5枚淋巴结14例（37.8%）。所有病例均成功完成经咽鼓管后下途径内镜经口手术。35例（94.6%）一期手术实现MRPLN全切，2例MRPLN累及颈内动脉壁者行次全切除。围手术期无严重并发症发生。随访期间（中位随访时间53.1个月），全切患者未见MRPLN复发。8例（21.6%）患者因不同原因死亡。经咽鼓管后下途径内镜经口切除MRPLN是一种可行、有效的手术方式，但长期效果仍需更长时间的随访及大宗病例总结。
