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目的 :探讨提高鼻咽癌放疗后残留或复发外科挽救治疗效果的手术方式。方法 :对经手术治疗鼻咽低分化鳞癌放疗后鼻咽部残留或复发患者 ,采取颈颌腭下颌骨翻转或上颌骨翻开及经口硬腭等手术入路切除复发病变 ;采用帽状腱膜瓣及胸大肌皮瓣进行术腔的修复和保护。结果 :手术并发症发生率为 16 % ,主要为局部感染或修复组织瓣坏死 ,术后后遗症较轻 ,腭鼻漏 4例 ,除 1例出现咬合错位外 ,其他病例功能及外观均得到满意的恢复。随诊达 3年以上 18例中死亡 8例 ,2例失访。结论 :根据复发肿瘤累及的部位及范围 ,选择最好的手术进路 ,争取相对彻底、安全地清除病变 ;同时采用方便可靠的修复办法 ,保护咽旁颅底重要结构 ,可以进一步提高手术治疗效果
Objective: To explore the ways to improve the effect of residual or recurrent surgical salvage treatment of nasopharyngeal carcinoma after radiotherapy. Methods: Surgical treatment of nasopharyngeal poorly differentiated squamous cell carcinoma after radiotherapy residual nasopharyngeal or recurrent patients, to take the maxillary and maxillary palate mandibular or tibial dislocation and oral hard palate and other surgical resection of the lesion; the use of cap-shaped tendon Membrane flap and pectoralis major flap for the repair and protection of the surgical cavity. Results: The incidence of surgical complications was 16%, mainly local infection or repair of tissue flap necrosis. Postoperative sequelae were mild, and palatal and nasal leakage was found in 4 cases. Except for 1 case, occlusal dislocation occurred, and other cases were satisfactory in appearance and function restore. Up to 3 years of follow-up in 18 cases of death in 8 cases, 2 cases were lost. Conclusion: According to the site and range of recurrent tumors involved, the best surgical approach is selected and relatively complete and safe removal of lesions is required. At the same time, the convenient and reliable repair method is used to protect the important structure of pharyngeal parapharyngeal skull and further improve the surgical treatment effect