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摘要:
鼻咽癌放疗后约10%~36%的患者复发。复发病灶通常对放疗不敏感,再程放疗疗效不佳,且会导致严重并发症,而外科治疗可以根治性切除癌灶并避免二次照射,成为复发鼻咽癌理想的挽救治疗方法。鼻外入路挽救手术创伤较大,且均存在不同程度的手术并发症。经鼻内镜鼻咽切除术因微创、切除范围不亚于鼻外入路,逐步成为rT1~2及部分rT3期患者的首选方案,相应的外科分期为复发鼻咽癌的分层治疗提供了科学依据。颈内动脉栓塞术、颅内外血管搭桥术等新技术的运用正在扩大挽救手术适应证,但广泛的外科切除是否优于二程放疗仍需更多实践验证。
Abstract:There are 10%-36% of nasopharyngeal carcinoma patients suffering from local and/or regional recurrence after primary treatment. The efficacy of re-irradiation to recurrent NPC (rNPC) has been suboptimal. Moreover, the adjacent sensitive organs had already received a high dose of radiation, thus the re-irradiation could result in severe radiation-related complications. Surgery could remove the radiation-resistant lesion directly and avoid complications of re-irradiation, therefore, salvage surgery has been well established and become the first-line treatment for rNPC. Various open surgical approaches had been devised for nasopharyngectomy but presented many surgical complications. In recent decade, the endoscopic nasopharyngectomy (ENPG) had gained popularity for rT1-2 and selected rT3 patients with its minimal invasiveness and the resection range is similar to most open surgeries. Additionally, a new Surgical Staging System established to aid clinicians in choosing the most suitable treatment for rNPC patients. Nowadays, the utilization of extracranial/intracranial vascular bypass and internal carotid artery embolization is widening the indications of salvage surgery, while whether the extended resection exhibits better survival than re-irradiation needs further clinical evidence.
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Key words:
- Recurrent /
- Nasopharyngeal carcinoma /
- Salvage surgery /
- Nasopharyngectomy /
- Endoscopic surgery
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作者贡献丁茜:文章撰写陈明远:指导文章修改及审校
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表 1 近十年鼻外进路挽救手术疗效及并发症总结
Table 1 Efficacy and major complications of open surgery for recurrent nasopharyngeal carcinoma in recent 10 years
表 2 经鼻内镜挽救性鼻咽切除术总结
Table 2 Treatment outcome of endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma
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