摘要
目的通过回顾性研究,探讨影响上颌窦恶性肿瘤复发的相关因素,明确上颌窦恶性肿瘤的治疗方式与转归,以提高患者的生存率。方法回顾1980～2003年间我院首诊治疗的56例上颌窦恶性肿瘤患者的治疗情况,其中肉瘤8例,上颌窦癌患者48例。按AJCC/UICC2002方法分期:T2级15例,T3级11例,T4级22例,N1级为2例,N2级为5例,无远处转移。治疗方式为放疗、化疗、单纯手术与综合治疗。手术方式为上颌骨部分切除术,上颌骨全切术和上颌骨全切加眶内容物摘除术。有颈部淋巴结转移的患者一期行颈淋巴结清扫术。放射治疗分为术前放疗与术后放疗。采用双原回归法(binarylogisticregression)检验复发率借以评估相关因素与复发的关系。结果①手术治疗的44例上颌窦恶性肿瘤患者,切缘阴性者35例,复发率为34.3%;切缘阳性者9例,复发率为100%。切缘阴性者复发率要低于切缘阳性者(P=0.021);②35例鳞状细胞癌中,低分化鳞状细胞癌复发率为78.6%(11/14),高于高分化鳞状细胞癌41.2%(7/17)的复发率(P=0.043);③肿瘤侵犯眶骨膜保留眼球的4例患者中,短期(6个月)复发率为100%,需二期手术行眼球摘出术,而一期实施眼球摘出术者9例,复发3例,复发率为33.3%。④以治愈为目的的6例上颌窦恶性肿瘤患者的再次复发率为33.3%;而姑息治疗的6例患者皆再次复发或局部未能控制。结论①对于上颌骨部分切除术,应该广泛切除,确保足够的安全缘以降低复发率;②肿瘤侵犯眶骨膜一期行眼球摘除术有利于降低术后复发率;③复发患者接受二次治疗仍可以降低再次复发率,延长生存时间。
OBJECTIVE To clarify the factors related to the recurrence of the maxillary sinus malignancy. METHODS Fifty-six patients with maxillary sinus malignancy treated in the hospital from 1980 to 2003 were enrolled in the study. There were 8 patients with sarcomas and 48 patients with carcinomas. According to AJCC/UICC2002, there were 15 patients with T2,11 with T3 and 22 with T4 respectively. Among the patients, 2 patients were N1 and 5 were N2. Radiotherapy, chemotherapy and surgery, alone or combined, were used for the treatment of maxillary sinus malignancy. Partial maxillectomy, total maxillectomy and total maxillectomy with exenteration of the orbital contents were the main surgical procedures. Neck dissection was performed for the patients with neck lymph node metastasis. Radiotherapy was used before （7 cases） or after（11 cases） surgery. RESULTS ① The recurrence rate was 34.3 %（12/35） in the group of negative surgical margin, and 100 %（9/9）in the group of positive margin. There was a significant difference between the two groups（P=0.021）. ② In the patients with squamous cell carcinoma, the recurrence rate in the group with low differentiated squamous cell carcinoma was 78.6 % and 47.1% in the group with high differentiated squamous cell carcinoma（P=0.043）. ③ In the patients with orbital involvement, the recurrence rates in the group of maxillectomy with and without exenteration of the orbital contents were 33.3 %（3/9） and 100 %（4/4） respectively （P 〈 0.05）. ④ For the curative purpose, 6 patient received the second surgery and the recurrence rate was 33.3 %, while in the group of the other 6 patients with alleviative purpose, the recurrence rate was 100 % （P =0.014）. CONCLUSION ① Partial maxillectomy should be performed with enough surgical margin.② Maxillectomy combined with exenteration of the orbital contents should be performed when the orbit is invaded to reduce the recurrence.③ Surgery is the reasonable choice for management of the recurrent maxillary malignancy.
出处
《中国耳鼻咽喉头颈外科》
北大核心
2005年第11期690-693,共4页
Chinese Archives of Otolaryngology-Head and Neck Surgery
关键词
上颌窦肿瘤
外科手术
眶内容物摘除术
放射疗法
Maxillary Sinus
Surgical Procedures,Operative
Orbit Evisceration
Radiotherapy
