颅底筋膜组织在早期复发性鼻咽癌内镜手术中的临床意义

doi:10.6040/j.issn.1673-3770.0.2024.382

摘要/Abstract

摘要： 既往对于复发性鼻咽癌(recurrent nasopharyngeal carcinoma, rNPC)常采用二程放化疗,但其疗效欠佳,5年生存率低且为患者带来放射性骨坏死、多发性颅神经损失、鼻咽大出血等严重并发症,严重影响患者生存质量甚至导致死亡。随着现代化手术持续发展,外科医生探索并证实内镜手术治疗rT1~ rT3复发性鼻咽癌相比放化疗具有并发症少、预后好的优势。对于部分位于中线区rT1~ rT3早期rNPC患者而言,内镜手术治疗能否彻底切除肿瘤且达到R0切除对患者预后具有至关重要的作用,其中颅底筋膜组织构成了颅底表面的重要结缔组织,附着于颅底肌肉浅面及黏膜深面,其结构致密及所处位置特殊,对恶性肿瘤具有天然的屏障作用。因此研究颅底筋膜组织对鼻咽手术切除范围的临床意义,可为临床诊疗提高指导作用。论文就颅底筋膜组织的结构特征及其抗肿瘤侵犯对于早期rNPC鼻咽切除术中的作用与意义进行综述。

关键词: 鼻咽癌, 筋膜, 颅底, 内镜手术, 鼻咽切除术

Abstract: Historically, the standard management of recurrent nasopharyngeal carcinoma(rNPC)involved two cycles of radiotherapy. However, the efficacy of the second cycle was suboptimal, resulting in a 5-year survival rate that fell below expectations and severe side effects, including radionecrosis, multiple cranial nerve deficits, and nasopharyngeal hemorrhage. These complications significantly impaired patients' quality of life and, in some cases, led to fatal outcomes.Recently, advancements in surgical techniques have emerged, offering a novel approach to managing rT1-rT3 recurrent nasopharyngeal carcinoma. For early-stage rNPC patients with rT1-rT3 tumors located in the midline area, the ability of endoscopic surgery to achieve complete tumor resection and R0 status is critical for their prognosis. The skull base fascial tissue, an integral connective tissue on the surface of the skull base, plays a crucial role. It adheres to the superficial aspect of the skull base muscles and the deep aspect of the mucous membranes. Its dense structure and strategic location provide a natural barrier against malignant tumors.Consequently, examining the clinical significance of the skull base fascial tissue in determining the extent of nasopharyngeal surgical resection can enhance clinical diagnostics and therapeutic strategies. This paper reviews the structural characteristics of the skull base fascia and its role and significance in resisting tumor invasion during early rNPC nasopharyngeal resection, highlighting its potential to improve clinical guidance in the management of this disease.

Key words: Nasopharyngeal carcinoma, Skull base, Fascia, Endoscopic surgery, Nasopharyngectomy

中图分类号:

R766

吴家荣,邱前辉. 颅底筋膜组织在早期复发性鼻咽癌内镜手术中的临床意义[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 108-113.

WU Jiarong, QIU Qianhui. The role and significance of the skull base fascial tissue barrier in endoscopic resection of locally early recurrent nasopharyngeal carcinoma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2025, 39(4): 108-113.

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