Clinical application of nasal mucosa flap in the repair of nasopharyngeal skull base bone exposure after radiotherapy for nasopharyngeal carcinoma
-
摘要: 目的 观察鼻黏膜瓣在鼻咽癌放疗后鼻咽颅底骨质裸露修复中的效果, 为鼻黏膜瓣在放疗后颅底骨质裸露中的修复提供依据。方法 回顾性分析8例行鼻内镜下鼻黏膜瓣修复鼻咽颅底骨质缺损或裸露的患者资料, 术后随访黏膜瓣存活情况、骨质缺损或裸露处黏膜上皮化情况, 以及患者主要临床症状改善和并发症情况。结果 除1例患者术后出现较严重的黏膜瓣坏死、骨质裸露, 余7例患者黏膜瓣存活且鼻咽部黏膜上皮恢复良好。术后大部分患者头痛、鼻臭等临床症状较术前改善。结论 鼻黏膜瓣是一种安全和微创的自体材料, 具有较好的生物相容性, 在修复放疗后鼻咽颅底骨质缺损或裸露中具有良好的应用前景, 值得临床推广。Abstract: Objective To observe the effect of nasal mucosa flap in the repair of nasopharyngeal skull base bone exposure after radiotherapy for nasopharyngeal carcinoma, and to provide a basis for the repair with nasal mucosa flap in skull base bone exposure after radiotherapy.Methods The clinical data of 8 patients who underwent nasal endoscopic surgery were analyzed retrospectively. The survival of mucosal flap, the mucosal epithelialization of bone defect or exposed site, the improvement of main clinical symptoms and complications were followed up after operation.Results Severe mucosal flap necrosis and bone exposure occurred in 1 case after operation, in the other 7 cases, the mucosal flap survived and the mucosal epithelium of nasopharynx recovered well. After operation, most of the patients' clinical symptoms such as headache and nasal odor were improved compared with those before operation.Conclusion Nasal mucosal flap is a safe and minimally invasive autogenous material with good biocompatibility. It has a good application prospect in repairing bone defect or exposure of nasopharyngeal skull base after radiotherapy and is worth popularizing in clinic.
-
-
表 1 8例患者的资料
编号 诊断 术后病理 头痛 鼻臭 黏膜瓣
血运创面愈合
情况术前 术后 术前 术后 1 鼻咽癌放疗后复发(rT1N0M0) 未分化型非角化性癌 0级 0级 无 无 存活 良好 2 鼻咽癌放疗后鼻咽、颅骨坏死 坏死组织 Ⅱ级 Ⅰ级 有 无 存活 良好 3 鼻咽癌放疗后鼻咽部坏死 坏死组织 0级 0级 有 无 存活 良好 4 鼻咽癌放疗后复发(rT2bN0M0) 分化型非角化性癌 0级 0级 无 无 存活 良好 5 鼻咽癌放疗后坏死 坏死组织 Ⅲ级 0级 有 无 存活 良好 6 鼻咽癌放疗后复发(rT3N0M0) 未分化型非角化性癌 Ⅱ级 Ⅱ级 有 有 坏死 不佳 7 鼻咽癌放疗后颅骨坏死 坏死组织 Ⅱ级 0级 无 无 存活 良好 8 鼻咽癌放疗后复发(rT3N0M0) 鳞状细胞癌 Ⅱ级 Ⅰ级 无 无 存活 良好 
下载: 导出CSV
-
[1] Zhang LF, Li YH, Xie SH, et al. Incidence trend of nasopharyngeal carcinoma from 1987 to 2011 in Sihui County, Guangdong Province, South China: an age-period-cohort analysis[J]. Chin J Cancer, 2015, 34(8): 350-357.
[2] 夏海龙, 郭贵军, 杨刚. 经鼻内镜术后颅底重建材料与方法研究进展[J]. 检验医学与临床, 2020, 17(21): 3220-3224. doi: 10.3969/j.issn.1672-9455.2020.21.044
[3] Mlk C, Jts W, Ep H, et al. Nasopharyngeal Carcinoma. [J]. Lancet(london, England), 2016, 10022: 1012-1024.
[4] Han F, Zhao C, Huang SM, et al. Long-term outcomes and prognostic factors of re-irradiation for locally recurrent nasopharyngeal carcinoma using intensity-modulated radiotherapy[J]. Clin Oncol(R Coll Radiol), 2012, 24(8): 569-576. doi: 10.1016/j.clon.2011.11.010
[5] Leong YH, Soon YY, Lee KM, et al. Long-term outcomes after reirradiation in nasopharyngeal carcinoma with intensity-modulated radiotherapy: A meta-analysis[J]. Head Neck, 2018, 40(3): 622-631. doi: 10.1002/hed.24993
[6] You R, Zou X, Hua YJ, et al. Salvage endoscopic nasopharyngectomy is superior to intensity-modulated radiation therapy for local recurrence of selected T1-T3 nasopharyngeal carcinoma-A case-matched comparison[J]. Radiother Oncol, 2015, 115(3): 399-406. doi: 10.1016/j.radonc.2015.04.024
[7] 徐文瑞. 侵袭转移相关标志物ELMO1、ROCK1和ROCK2在鼻咽癌组织中的表达及临床意义[D]. 青岛大学, 2020.
[8] Lee A, Ng WT, Chan J, et al. Management of locally recurrent nasopharyngeal carcinoma[J]. Cancer Treat Rev, 2019, 79: 101890. doi: 10.1016/j.ctrv.2019.101890
[9] Hao CY, Hao SP. The Management of rNPC: Salvage Surgery vs. Re-irradiation[J]. Curr Oncol Rep, 2020, 22(9): 86. doi: 10.1007/s11912-020-00949-0
[10] 徐文瑞, 姜彦. 复发鼻咽癌挽救性手术方法研究进展[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 35-38. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYU201902007.htm
[11] Kouyoumdjian P, Gille O, Aurouer N, et al. Cervical vertebral osteoradionecrosis: surgical management, complications and flap coverage--a case report and brief review of the literature[J]. Eur Spine J, 2009, 18 Suppl 2: 258-264.
[12] Vlantis AC, Wong E, Chiu TW, et al. Vastus Lateralis Muscle Free Flap for Skull Base Osteoradionecrosis in Nasopharyngeal Carcinoma[J]. J Neurol Surg B Skull Base, 2018, 79(4): 349-352. doi: 10.1055/s-0037-1608714
[13] Zou X, Wang SL, Liu YP, et al. A curative-intent endoscopic surgery for postradiation nasopharyngeal necrosis in patients with nasopharyngeal carcinoma[J]. Cancer Commun(Lond), 2018, 38(1): 74.
[14] Hua YJ, Chen MY, Qian CN, et al. Postradiation nasopharyngeal necrosis in the patients with nasopharyngeal carcinoma[J]. Head Neck, 2009, 31(6): 807-812. doi: 10.1002/hed.21036
[15] Chen MY, Mai HQ, Sun R, et al. Clinical findings and imaging features of 67 nasopharyngeal carcinoma patients with postradiation nasopharyngeal necrosis[J]. Chin J Cancer, 2013, 32(10): 533-538. doi: 10.5732/cjc.012.10252
[16] 赵天峰, 石照辉, 许敏, 等. 鼻咽颅底放射性骨髓炎临床分析[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(5): 436-440. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202005013.htm
[17] 陈卓, 邱前辉, 粘家斌, 等. 鼻咽癌放疗后大范围颅底骨坏死的内镜手术处理及颅底重建原则[J]. 中华耳鼻咽喉头颈外科杂志, 2016, 51(12): 881-886. doi: 10.3760/cma.j.issn.1673-0860.2016.12.001
[18] 高俊潇, 邱前辉. 黏膜瓣在鼻咽癌放疗后鼻内镜手术修复颅底组织缺损中的应用[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 46-50. https://www.cnki.com.cn/Article/CJFDTOTAL-SDYU201902009.htm
[19] Jang JW, Chan AW. Prevention and management of complications after radiotherapy for skull base tumors: a multidisciplinary approach[J]. Adv Otorhinolaryngol, 2013, 74: 163-173.
[20] Chang KP, Tsang NM, Chen CY, et al. Endoscopic management of skull base osteoradionecrosis[J]. Laryngoscope, 2000, 110(7): 1162-1165.
[21] Chapchay K, Weinberger J, Eliashar R, et al. Anterior Skull Base Reconstruction following Ablative Surgery for Osteoradionecrosis: Case Report and Review of Literature[J]. Ann Otol Rhinol Laryngol, 2019, 128(12): 1134-1140. doi: 10.1177/0003489419865558
[22] Wei WI, Lam KH, Sham JS. New approach to the nasopharynx: the maxillary swing approach[J]. Head Neck, 1991, 13(3): 200-207. doi: 10.1002/hed.2880130306
[23] Fee WE Jr, Gilmer PA, Goffinet DR. Surgical management of recurrent nasopharyngeal carcinoma after radiation failure at the primary site[J]. Laryngoscope, 1988, 98(11): 1220-1226.
[24] Khoo ML, Soo KC, Gullane PJ, et al. Resurfacing of the nasopharynx after nasopharyngectomy using a free radial forearm flap[J]. Head Neck, 2001, 23(10): 916-922.
[25] Chakravarthi S, Gonen L, Monroy-Sosa A, et al. Endoscopic Endonasal Reconstructive Methodsto the Anterior Skull Base[J]. Semin Plast Surg, 2017, 31(4): 203-213.
-
图(2)
表(1)
计量
- 文章访问数: 979
- PDF下载数: 355
- 施引文献: 0