鼻内镜下使用不同修复材料治疗30例鼻咽癌放疗后颅底骨坏死累及颈内动脉的临床疗效分析

Analysis of the Therapeutic Outcomes of Different Repair Materials Used Under Endoscopy in 30 Patients with Nasopharyngeal Carcinoma Radiation-Induced Skull Base Osteoradionecrosis Involving the Internal Carotid Artery

摘要:

目的 总结鼻内镜下使用不同修复材料治疗鼻咽癌放疗后颅底骨质坏死累及颈内动脉的总体临床疗效、并发症及随访结果。方法 回顾性分析2021年1月至2025年6月于广西壮族自治区人民医院耳鼻咽喉头颈科收治的30例鼻咽癌放疗后颅底骨质坏死累及颈内动脉的患者的临床资料。所有患者均接受鼻内镜下颅底坏死病灶清除术，根据颅底缺损情况选择颞肌瓣（8例）、带蒂鼻中隔黏膜瓣（8例）、生物材料（8例）或阔筋膜（6例）进行修复重建。观察术后症状改善、并发症及生存情况。采用Kaplan?Meier法绘制生存曲线。结果30 例患者术后随访 7~62 个月，中位随访时间 22 个月。术前主要症状包括头痛 18 例（60.0%）、鼻臭 12 例（40.0%）、鼻出血 8 例（26.7%）。术后症状改善情况：头痛 13/18（72.2%），鼻臭 10/12（83.3%），鼻出血 6/8（75.0%）；术后总体症状改善 23 例（76.7%），无改善 4 例，部分改善（头痛未缓解但鼻臭改善）3 例。同期行气管切开 9 例（30.0%）；术后发生大出血 6 例（20.0%）；其中颞肌瓣组术后大出血发生率为 0（0/8），低于其他材料组的 27.3%（6/22）。术后随访期间死亡 4 例（13.3%），1、2、3 年总体生存率分别为 93.3%、89.3% 和 80.3%。 结论 鼻内镜下坏死病灶清除联合颅底重建是治疗鼻咽癌放疗后颅底骨质坏死累及颈内动脉的有效手段，术后症状改善确切。颞肌瓣具有组织量充足、血供可靠的优点，在降低术后大出血风险方面具有一定的优势。本研究为探索性小样本研究，所有结论仅为初步结果，尚需更大样本量和更长随访时间的研究加以验证。

Abstract:

Objective To summarize the overall clinical outcomes, complications, and follow-up results of endoscopic repair using different reconstruction materials for patients with skull base osteoradionecrosis involving the internal carotid artery after radiotherapy for nasopharyngeal carcinoma. Methods The clinical data of 30 patients with nasopharyngeal carcinoma radiation-induced skull base osteoradionecrosis involving the internal carotid artery who were treated in the Department of Otorhinolaryngology–Head and Neck Surgery at Guangxi Zhuang Autonomous Region People’s Hospital from January 2021 to June 2025 were retrospectively analyzed. All patients underwent endoscopic debridement of necrotic skull base lesions. Reconstruction was performed using different materials according to the extent and characteristics of skull base defects, including temporal muscle flaps (n=8), pedicled nasal septal mucosal flaps (n=8), biological materials (n=8), or fascia lata (n=6). Postoperative symptom improvement, complications, and survival outcomes were evaluated. Kaplan–Meier survival analysis was performed to estimate overall survival. Results The median follow-up duration was 22 months (range, 7–62 months). The most common preoperative symptoms were headache in 18 cases (60.0%), foul nasal odor in 12 cases (40.0%), and epistaxis in 8 cases (26.7%). After surgical intervention, symptom improvement was observed in 13/18 (72.2%) for headache, 10/12 (83.3%) for foul nasal odor, and 6/8 (75.0%) for epistaxis. Overall, symptomatic improvement was achieved in 23 patients (76.7%), while 4 patients showed no improvement, and 3 patients experienced partial improvement (headache unresolved but foul nasal odor relieved). Tracheostomy was performed in 9 patients (30.0%) during the same hospitalization. Postoperative major hemorrhage occurred in 6 patients (20.0%); notably, the incidence of major hemorrhage in the temporalis muscle flap group was 0% (0/8), which was lower than that in the other material groups [27.3% (6/22)]. During follow-up, 4 patients (13.3%) died, with causes including carotid artery rupture with massive hemorrhage (n = 3) and cachexia (n = 1). The 1-, 2-, and 3-year overall survival rates were 93.3%, 89.3%, and 80.3%, respectively. Conclusion Endoscopic debridement combined with skull base reconstruction is an effective treatment strategy for nasopharyngeal carcinoma radiation-induced skull base osteoradionecrosis involving the internal carotid artery, providing substantial postoperative symptom relief. The temporalis muscle flap offers advantages including sufficient tissue volume and reliable vascular supply, and exhibits certain benefits in reducing the risk of postoperative massive hemorrhage. As an exploratory study with a small sample size, the conclusions of this study should be considered preliminary and require validation through larger-scale studies with longer follow-up periods.