Outcomes and Complications of Endoscopic Approaches for Malignancies of the Paranasal Sinuses and Anterior Skull Base
Outcomes and Complications of Endoscopic Approaches for Malignancies of the Paranasal Sinuses and Anterior Skull Base
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DOI：
10.1177/000348941312200110
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发表时间：
2013-01-01
影响因子：
1.4
通讯作者：
Chiu, Alexander G.
中科院分区：
文献类型：
--
作者：
Suh, Jeffrey D.;Ramakrishnan, Vijay R.;Chiu, Alexander G.
目的：鼻窦恶性肿瘤传统上采用各种外切口入路治疗。内窥镜鼻腔手术的最新进展使其中一些肿瘤可以通过内窥镜进行治疗。本研究的目的是评估鼻内窥镜手术治疗鼻窦恶性肿瘤的疗效和并发症。方法：回顾2002-2010年间在三级医疗机构接受鼻内窥镜或鼻内窥镜辅助手术治疗的鼻窦或颅底恶性肿瘤患者的临床资料。收集了患者的症状、肿瘤类型、手术技术和术后病程的数据。结果：在总共49例患者中，36例(73%)接受了内窥镜手术，13例(27%)接受了内窥镜辅助手术。最常见的肿瘤类型是肉瘤(9例)，其次是鳞癌(8例)、腺癌(8例)和黑色素瘤(7例)。所有患者的平均随访时间为3.58年(1.1~8.8年)。开放手术比内窥镜手术并发症更常见(23.1%比5.6%；p=0.11)。开放入路的内科并发症明显更常见(38.5%比8.3%；p=0.02)。疾病特异性死亡率为8%(4/49)。肿瘤局部复发率为16%(8/49)。3年无瘤生存率分别为86.8%和67.7%(p=0.047)，但内窥镜组患者的T分期较低(p=0.0068)，ASA值也较低(p=0.03)。结论：随着颅底重建技术的进步、外科技术的进步和技术的进步，鼻内窥镜鼻窦和颅底的手术入路逐渐成熟。这项研究证明了鼻内窥镜手术治疗鼻窦和颅底恶性肿瘤的相对安全性和实用性。在精心选择的患者中，内窥镜方法显示出与传统手术相当的存活率，且围手术期并发症较少。通过适当的计划和仔细的手术决策，内窥镜手术在治疗鼻腔恶性肿瘤方面显示出作为一种微创替代方案的前景。
Objectives: Malignant tumors of the paranasal sinuses are traditionally approached by a variety of external incisions. Recent advances in endoscopic endonasal surgery have allowed for some of these tumors to be treated endoscopically. The purpose of this study was to assess the outcomes and complications of the endoscopic approach in a series of patients with paranasal sinus malignancies.Methods: A retrospective chart review was performed of patients with sinonasal or skull base malignancies treated with endoscopic or endoscopic-assisted resections at a tertiary care institution from 2002 to 2010. Patient data were collected on symptoms, tumor type, operative technique, and postoperative course. Baseline risk factors, overall and disease-free survival data, and surgical outcomes were compared between the two groups.Results: Of the total 49 patients, 36 (73%) underwent an endoscopic approach and 13 (27%) underwent endoscopic-assisted approaches. Sarcomas (9 cases) were the most common tumor type, followed by squamous cell carcinoma (8), adenocarcinoma (8), and melanoma (7). The mean follow-up time for all patients was 3.58 years (range, 1.1 to 8.8 years). Surgical complications were more frequent with open approaches than with endoscopic approaches (23.1% versus 5.6%; p = 0.11). Medical complications were significantly more common with open approaches (38.5% versus 8.3%; p = 0.02). The disease-specific mortality rate was 8% (4 of 49). The local tumor recurrence rate was 16% (8 of 49). The 3-year disease-free survival rates were 86.8% in the endoscopic group and 67.7% in the open group (p = 0.047); however, the patients in the endoscopic group had lower T stages (p = 0.0068) and lower ASA scores (p = 0.03).Conclusions: Endoscopic approaches to the sinuses and skull base have become progressively more sophisticated with advances in skull base reconstruction, advances in surgical technique, and improvements in technology. This study demonstrates the relative safety and utility of the endoscopic approach for sinonasal and skull base malignancies. In carefully selected patients, endoscopic approaches demonstrate survival rates comparable to those of traditional surgery, and fewer perioperative complications. With appropriate planning and careful surgical decision-making, endoscopic surgery shows promise as a minimally invasive alternative in the treatment of sinonasal malignancies.