- 期刊
以內視鏡手術切除鼻腔鼻竇惡性腫瘤
Endoscopic Surgery for Malignant Sinonasal Tumors
摘要
鼻腔鼻竇惡性腫瘤(malignancy sinonasal tumor)只佔所有頭頸部腫瘤的少數，約佔上呼吸道腫瘤的3%。大部分的患者在診斷時均屬於較晚期且已侵犯至鄰近的組織。而鼻竇及鼻腔附近有顱底、中樞神經及眼睛，因而在治療上具有極大的挑戰。本研究報告以內視鏡的方式來治療鼻腔鼻竇惡性腫瘤。彰化基督教醫院耳鼻喉暨頭頸科從2000年9月至2002年12月共有5名因原發鼻腔鼻竇惡性腫瘤接受內視鏡手術。性別為4名男性及l名女性，年齡分佈為33歲至68歲，平均年齡為51.6歲。患者求診時的症狀以鼻塞及流鼻血為主。術前皆安排電腦斷層或核磁共振，其腫瘤主要位於篩竇。這5名患者以經鼻內視鏡手術的方式將整個腫瘤切除。其中l名患者有顱底侵犯，經內視鏡切除腫瘤併以fascia lata修補腦膜及接受放射線治療，其餘4名並未接受術後放射線治療。而所有患者無手術相關的併發症產生。目前患者已追蹤12至39個月，平均追蹤27個月，至今未有局部復發的情形。我們的報告顯示，只要慎選患者，以內視鏡手術的方式來處理鼻腔鼻竇惡陸腫瘤，不僅可以減少外觀的破壞並可降低併發症。對於某些鼻腔鼻竇惡性腫瘤，如果經適當的評估，經鼻內視鏡手術應是一種可嘗試的方法。
並列摘要
Malignant sinonasal neoplasms resulting from head-and-neck cancers constitute only a minority of such cancers, they representing about 3% of head-and-neck cancers. Most patients at diagnosis are categorized as featuring a late stage of tumor development, with tumors typically having invaded surrounding tissues. The base of the skull, the central nervous system and the eyes are located at/near the maxillary sinus and the nasal cavity, such that tumor treatment constitutes a great challenge for clinicians. This study was intended to select a particular sub-group of malignant sinonasal-neoplasm patients the tumors from whom revealed a distinct pathology and location, and which cancers we treated using endoscopy. Five patients (four males) suffering from sinonasal cancers were treated with endoscopic surgery at Changhua Christian Hospital from Sep. 2000 to Dec. 2002 inclusively. Patient ages ranged from 33 to 68 years (mean=51.6). Major presenting symptoms were nasal obstruction and nasal bleeding. All the patients underwent CT or MRI prior to surgery, we finding that the major tumor was located at the ethmoid sinus. All the tumors were successfully removed by endoscopic surgery. One tumor had invaded the base of the skull, so the tumor was resected and remaining defect repaired by use of fascia lata. Following surgery, this patient underwent radiotherapy, although the others chose not to accept radiotherapy. No surgery-associated complications arose for any of the patients. All patients were routinely followed up for from 12 to 39 months (mean=27). To date, we have noted no local recurrence of tumor. According to our findings, endoscopic surgery for selective sinonasal cancers, not only elicits less destmction of facial anatomy than does the more conventional surgical aftemative, but it also tends to reduce surgery-associated complications. Thus, endoscopic surgery is a feasible option for the effective treatment of sinonasal cancer.