Endoscopic resection of malignant tumors of the nose and sinuses
Endoscopic resection of malignant tumors of the nose and sinuses
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DOI：
10.2500/ajr.2007.21.2957
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发表时间：
2007-01-01
期刊：
影响因子：
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通讯作者：
Wei, William I.
中科院分区：
文献类型：
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作者：
Lund, Valerie;Howard, David J.;Wei, William I.
背景资料：自内窥镜手术引入以来，其作用已逐渐扩展到包括鼻窦肿瘤在内的一系列病理，并通过修复显著颅底缺损的能力而得到促进。然而，恶性肿瘤的罕见性和长期的自然史使得很难累积队列与颅面切除术的既定金标准相媲美，方法：在这项前瞻性队列研究中，经过组织学确认和分期成像方案，认为合适的患者提供了选择完全内镜切除术作为颅面切除术的替代方案。该程序在冷冻切片控制下进行。长期随访方案包括MRI和麻醉下检查，前2年间隔3 ~ 4个月，其后间隔6个月。结果：共有49例患者，男26例，女23例，年龄34-88岁（平均60岁）。随访6 ~ 126个月，平均36个月。37例行放疗，14例行辅助化疗。广泛的病理包括15例腺癌，11例恶性黑色素瘤和11例嗅神经母细胞瘤。平均住院5天，无明显术后并发症。36例患者存活良好，7例患者有残留病变，4例患者死于疾病，2例患者死于并发症。3例患者随后转为颅面切除术。总生存率为88%，在5 years.Conclusion：这些初步结果表明，内窥镜切除术可以提供一种替代颅面切除术在选定的情况下，鼻窦恶性肿瘤。
Background: Since the introduction of endoscopic surgery, its role has been gradually extended to encompass a range of pathologies, including sinonasal tumors, facilitated by the ability to repair significant skull-base defects. However, the rarity and long natural history of malignant tumors make it difficult to accrue cohorts comparable with the established gold standard of craniofacial resection,Methods: In this prospective cohort study, after histological confirmation and a staging imaging protocol, patients deemed suitable were offered the option of an entirely endoscopic resection as an alternative to craniofacial resection. The procedure was performed under frozen section control. The long-term follow-up protocol included both MRI and examination under anesthesia at 3- to 4-month intervals in the first 2 years and 6-month intervals thereafter.Results: There were 49 patients, 26 men and 23 women, aged 34-88 years (mean, 60 years). Follow-up ranged from 6 to 126 months (mean, 36 months). Thirty-seven cases underwent radiotherapy and 14 cases underwent adjuvant chemotherapy. A wide range of pathologies included 15 cases of adenocarcinoma, 11 malignant melanomas, and 11 olfactory neuroblastomas. Hospital stay was a mean of 5 days, with no significant postoperative complications. Thirty-six patients are alive and well, 7 patients have residual disease, 4 patients are dead of disease, and 2 patients have died of intercurrent disease. Three patients have been subsequently converted to craniofacial resection. Overall survival was 88% at 5 years.Conclusion: These initial results suggest that endoscopic resection may provide an alternative to craniofacial resection in selected cases of sinonasal malignancy.