经鼻内镜鼻咽切除及带血管蒂鼻腔粘膜瓣修复术治疗T1T2a和选择后课件.ppt

1、研究背景研究背景鼻咽癌首选放射治疗，放疗后单纯局部复发率约10%；救援性外科治疗是局部复发鼻咽癌最佳治疗手段之一；鼻咽切除术也是鼻咽腺癌、肉瘤等的治疗方法之一；鼻外进路：空间大但创伤大鼻内进路：微创但空间狭窄外科切除：广泛切除但操作难度大消融治疗：操作简便但适应症狭窄？Endoscopic surgeryOncologicalEndoscopic nasopharyngectomy Conventional open surgery 经鼻内镜鼻咽切除术经鼻内镜鼻咽切除术rNPC,T2bN0M0abcCBAPre-OpPost-Op手术前后MRI对比手术前后MRI对比结果结果 1N=67Male

2、:female15 male52Radiotherapy:one circle53 two circles14rT stages(UICC2002):rT127 rT2a7rT2b22 rT311Median age,years(range)49(2771)From Oct 2004 to Jan 2010 with median follow-up 28 months(468 m)From Oct 2004 to June 2009 with median follow-up 31 months(668 m)生存曲线Surgical approachnOp time(min)Blood lo

3、ss(ml)Post-op hospital stay(d)Ectro-pionNerve tran-sectionPalatal fistulatrismusImpaired swallow-ingNasal regurg-itationOthers Chen MY1Transnasal with endoscopy371951175000-008aWillard EF2TanspalatalTranscervic Transmaxilla1527010727.9-3-1-43730098164510To EW3Transnasal with SNG1518591711000012Maxil

4、la swing122401398329634253Mandibular swing5387159654031211maxilla and mandibular3585127063220321a:secretory otitis media 1.Chen MY,et al.Endoscopic nasopharyngectomy for locally recurrent nasopharyngeal carcinoma.Laryngoscope 2009;119(3):516-522 2.Willard EF,et al.Nasopharyngectomy for recurrent nas

5、opharyngeal cancer:a 2-to 17-year follow-upJ.Arch-Otolaryngol-Head-Neck-Surg,2002,128(3):280-284.3.To EW,et al.The use of stereotactic navigation guidance in minimally invasive transnasal nasopharyngectomy:a comparison with the conventional open transfacial approachJ.Br-J-Radiol,2002,75(892):345-350

6、.与鼻外进路鼻咽切除术的对比与鼻外进路鼻咽切除术的对比Group 1（N=18）Group 2（N=18）P ValueGender:female34 male15140.317rT stages(UICC2002):rT199 rT2a11rT2b881.0Radiotherapy:one circle1313 two circles551.0Age(years):49.313.448.88.70.931Healing Time(weeks)13.16.526.3270.016From Oct 2004 to June 2009 with median follow-up 31 months

7、(668 m)结果2：中鼻甲粘膜瓣修复效果 第三部分：第三部分：外科治疗非鳞癌初治鼻咽恶性肿瘤1.放化疗不敏感的病理类型或患者拒绝放射治疗2.鼻咽肿瘤范围局限，无淋巴结和远处转移3.充分的知情同意和良好的随访条件4.多学科专家会诊共同制定治疗计划结果结果 3:单纯外科治疗鼻咽恶性肿瘤Pathologic DignosisN=77T stageFollow-upResultLocal recurrent NPC:Newly non-metastasis NP malignancies:carcinoma in situ AdenocarcinomaSarcomaAdenoid cystic ca

8、rcinoma Extramedullary plasmacytoma Spindle cell hemangieoendothelioma Hemangiopericytoma 67102221111TisT1,T2aT1,T3T1T1T3T2b28(468)32(858)28,48 14,588,1547403234ADF in PaADF(both)ADF(both)ADF*,ALP*DLRADFADFALPADF：alive and disease free;ALP：alive with local persistence;ALR：alive with local recurrence

9、;DLR:dead of local recurrece;*post-operational radiotherapy.1.创新的经鼻内镜鼻咽切除术治疗rT1/T2a和选择后rT2b/T3期局部复发鼻咽癌微创、安全并且有效;2.创新的带血管蒂鼻腔粘膜瓣能有效而微创地修复局部复发鼻咽癌的手术创面；3.基于经鼻内镜鼻咽切除术的单纯外科治疗，为部分拒拒绝放射治疗绝放射治疗的高选择后高选择后的非鳞癌初治鼻咽恶性肿瘤患者提供一个新的备选治疗方法。结论结论致谢！致谢！致谢：致谢：中山大学肿瘤防治中心鼻咽科郭翔、钱朝南、李宁炜、曹卡加、麦海强、邓满泉、莫浩元、郭灵、邱枋、向燕群、黄培钰、罗东华、陈秋燕、孙蕊

10、等全体同事；中山大学肿瘤防治中心放疗科卢泰祥、刘孟忠、马俊、赵充、罗伟、吴少雄、胡伟汉、谢方云、苏勇、卢丽霞、韩非、孙颖、曹新平、李群、刘慧等全体同事；中山大学肿瘤防治中心头颈外科杨安奎、李浩、刘学奎、陈伟超等全体同事；中山大学肿瘤防治中心神经肿瘤科陈忠平、牟永告等全体同事；中山大学肿瘤防治中心影像科谢传淼教授、核医学科樊卫教授等；中山大学附属第一医院耳鼻喉科文卫平、李添应教授等；香港大学玛丽医院韦霖教授、陈汝威医师等；荷兰癌症中心列文虎克医院头颈肿瘤科Bing Tang教授、Geerten医师；谢谢大家！谢谢大家！课题组：课题组：中山大学肿瘤防治中心鼻咽科：洪明晃教授、华贻军、万香波、朱玉亮等。