内镜经口入路行鼻咽癌放疗后肿瘤残留切除或咽旁隙转移及复发淋巴结清扫术

Endoscopic transoral approach for dissection of residual tumor and metastatic or recurrent parapharyngeal lymph node in postirradiated nasopharyngeal carcinoma patients

摘要:

 目的探讨内镜经口入路行鼻咽癌放疗后咽旁隙残留或复发淋巴结清扫术的有效性及可行性。方法回顾性分析2015年3月～2017年10月南方医科大学珠江医院耳鼻咽喉科收治的12例鼻咽癌放疗后咽旁隙淋巴结残留或复发患者的临床资料，所有患者术前均行影像学检查诊断，其中5例单纯行内镜下经口入路咽旁隙淋巴结清扫术，7例因有鼻咽癌原发灶残留或者复发同时行鼻咽-颅底肿瘤切除术。结果12例（共13侧）患者手术顺利，术后均未出现声嘶、进食呛咳及颈内动脉损伤等并发症，1例患者出现口内切口感染，1例患者切口部分缝线松脱，均经对症处理后痊愈。术后随访至2018年4月，中位随访23个月（6～36个月），所有患者术后均未出现咽旁隙内再发转移灶。结论内镜下经口入路行鼻咽癌放疗后咽旁隙淋巴结清扫术可有效地切除转移灶，且手术创伤小，并发症少，术后恢复快，具有临床应用价值。

关键词: ;鼻咽癌|咽旁隙|手术入路|鼻内镜|淋巴转移

Abstract:

 ObjectiveTo investigate the efficacy and feasibility of endoscopic transoral approach for dissection of residual or recurrent lymph node in parapharyngeal space of postirradiated nasopharyngeal carcinoma (NPC) patients.MethodsClinical data of 12 postirradiated NPC patients with residual or recurrent parapharyngeal lymph nodes hospitalized in our department between March 2015 and Oct 2017 were analyzed retrospectively. All patients received preoperative imaging examination for diagnosis and surgical dissection of residual or recurrent lymph nodes via endoscopic transoral approach. To 7 cases with residual or recurrent NPC, simultaneous nasopharyngealskull base tumor resection was performed.ResultsSurgical dissection of residual or recurrent parapharyngeal lymph node was accomplished successfully via endoscopic transoral approach in all 12 patients (13 sides). No postoperative complications such as hoarseness, coughing and internal carotid artery injury occurred. Intraoral incision infection in one case and seam slippage in another got recovered after symptomatic treatment. All patients had been followed up until March 2018, with a median followup duration of 23 months (rangeed from 6 to 36 months). All patients had no recurrent metastasis in the parapharyngeal space.ConclusionWith advantages of less trauma, few complications, and rapid postoperative recovery, dissection of residual or recurrent lymph node in parapharyngeal space of postirradiated NPC patients can be achived effectively via endoscopic transoral approach, which is worth clinical application.

Key words: ;Nasopharyngeal neoplasm|Parapharyngeal space|Surgical approach; Nasal endoscope| Lymphatic metastasis