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

doi:10.6040/j.issn.1673-3770.0.2019.049

摘要/Abstract

摘要： 目的

探索使用游离黏膜瓣与带蒂黏膜瓣在鼻咽癌放疗后颅底手术中的临床应用。

方法

回顾分析2018年7月至2018年11月南方医科大学珠江医院耳鼻喉科应用黏膜瓣修复鼻咽癌放疗后42例患者病例资料，带蒂黏膜组织瓣修复17例，游离鼻甲黏膜瓣修复25例，失败后再次手术带蒂黏膜组织瓣9例。术后随访黏膜瓣存活情况。

结果

17例行带蒂黏膜瓣修复手术者中，12例黏膜瓣存活良好(70.59%)，3例黏膜瓣愈合欠佳(17.65%)，2例生长差(11.76%)；二次手术率为17.65%(3例次)。25例行游离黏膜瓣修复手术者中，13例愈合良好(52.00%)，10例愈合欠佳(40.00%)，2例愈合差(8.00%)；二次手术率为24.00%(6例次)。9例再次手术的手术方式均为带蒂黏膜瓣修复术，术后8例黏膜瓣愈合良好，1例愈合差。观察发现首程放疗与再程放疗对黏膜瓣存活的影响差异有统计学意义[U=898.50, P=0.001(标准化后)]，且首程放疗比再程放疗黏膜瓣愈合好；鼻咽癌复发与颅底骨坏死性黏膜瓣修复效果差异有统计学意义[U=654.50, P=0.017(标准化后)]，且骨坏死患者黏膜瓣预后差；消除放疗及骨坏死影响因素分析，带蒂黏膜瓣修复与游离黏膜瓣修复术后黏膜存活情况无统计学差异[U=746.00, P=0.157(标准化后)]。

结论

黏膜瓣修补是鼻咽癌放疗后鼻内镜手术修复颅底组织缺损的重要方法，不仅经济实惠，无排斥，而且取材方便。放疗次数及是否发生骨坏死对黏膜瓣存活影响较大，修复方式对瓣膜的存活无明显影响。

关键词: 鼻咽肿瘤, 放射治疗, 骨坏死, 修复外科手术, 黏膜瓣

Abstract: Objective

To explore the clinical application of free mucosal flap and vascularized mucosal flap in skull base surgery after radiotherapy for nasopharyngeal carcinoma.

Methods

A retrospective analysis of 42 cases of patients with nasopharyngeal carcinoma, who underwent radiotherapy in the Department of Otolaryngology, Zhujiang Hospital of Southern Medical University, was performed. All patients underwent mucosal flap surgery between July and November 2018. Seventeen patients underwent reconstruction surgery using a vascularized mucosal flap, and 25 underwent reconstruction surgery using a free mucosal flap. Nine patients underwent surgery twice. The area of the free mucosal flap was 4-6 cm², and the area of the vascularized mucosa flap was 6-20 cm².

Results

Vascularized mucosal flaps were used in 17 patients: 12 mucosal flaps healed well (70.59%), 3 did not heal completely (17.65%), and 2 showed poor healing (11.76%). Three of these patients underwent a second surgery (17.65%). Free mucosal flaps were used in 25 patients: 13 mucosal flaps healed well (52.00%), 10 did not heal completely (40.00%), and 2 showed poor healing (8.00%). Six of these patients underwent a second surgery (24.00%). Vascularized mucosal flap was used in the second surgery in all 9 patients: in 8 of these patients, flap healing was good, whereas one patient showed poor healing. It was observed that the number of courses of radiotherapy had significant effects on the survival of mucosal flaps (P=0.007): mucosal flap healing was better in the first radiotherapy than in the second. Recurrence of nasopharyngeal carcinoma and osteoradionecrosis of the skull base after radiotherapy also had a significant effect on mucosal flap healing (P=0.017). The healing of mucosal flaps in patients with osteonecrosis was poor. Regardless of the administration of a second course of radiotherapy or occurrence of osteonecrosis, there was no significant difference in mucosal survival between the vascularized mucosal flap and free mucosal flap repair (P=0.153).

Conclusion

Mucosal flap repair is an important method for endoscopic surgery to repair skull base defects after radiotherapy for nasopharyngeal carcinoma. This procedure is not only economical and non-repulsive, but is also easy to perform. The number of radiotherapy treatments and occurrence of osteonecrosis have a significant influence on the survival of mucosal flaps. The repair method had no significant effect on the survival of the flap.

Key words: Nasopharyngeal neoplasms, Radiotherapy, Osteoradionecrosis, Reconstructive surgical procedures, operative, Mucosal flaps

中图分类号:

R762

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.

Junxiao GAO,Qianhui QIU. Efficacy of endoscopic surgery using two types of flaps to reconstruct the skull base after radiotherapy for nasopharyngeal carcinoma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 46-50.

图/表 1

图1

参考文献 9

1	Torre LA , Bray F , Siegel RL , et al. Global cancer statistics, 2012[J]. CA Cancer J Clin, 2015, 65 (2): 87- 108. doi: 10.3322/caac.21262
2	Chua MLK , Wee JTS , Hui EP , et al. Nasopharyngeal carcinoma[J]. Lancet, 2016, 387 (10022): 1012- 1024. doi: 10.1016/S0140-6736(15)00055-0
3	Zhao W , Lei H , Zhu XD , et al. Investigation of long-term survival outcomes and failure patterns of patients with nasopharyngeal carcinoma receiving intensity-modulated radiotherapy: a retrospective analysis[J]. Oncotarget, 2016, 7 (52): 86914- 86925. doi: 10.18632/oncotarget.13564
4	Tuan JK , Ha TC , Ong WS , et al. Late toxicities after conventional radiation therapy alone for nasopharyngeal carcinoma[J]. Radiother Oncol, 2012, 104 (3): 305- 311. doi: 10.1016/j.radonc.2011.12.028
5	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
	CHEN Zhuo , QIU Qianhui , NIAN Jiabin , et al. Endoscopic surgery and reconstruction for extensive osteoradionecrosis of skull base after radiotherapy for nasopharyngeal carcinoma[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2016, 51 (12): 881- 886. doi: 10.3760/cma.j.issn.1673-0860.2016.12.001
6	Lee AW , Ma BB , Ng WT , et al. Management of nasopharyngeal carcinoma: current practice and future perspective[J]. J Clin Oncol, 2015, 33 (29): 3356- 3364. doi: 10.1200/JCO.2015.60.9347
7	Setton J , Han J , Kannarunimit D , et al. Long-term patterns of relapse and survival following definitive intensity-modulated radiotherapy for non-endemic nasopharyngeal carcinoma[J]. Oral Oncol, 2016, 53: 67- 73. doi: 10.1016/j.oraloncology.2015.11.015
8	粘家斌, 邱前辉. 鼻咽癌放疗后残留或复发不同rT分级的内镜挽救性手术特点分析[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30 (6): 459- 463. doi: 10.13201/j.issn.1001-1781.2016.06.010
	NIAN Jiabin , QIU Qianhui . Analysis of the characteristics of salvage endoscopic surgery for residual or recurrent nasopharyngeal carcinoma with different rT grading after radiotherapy[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2016, 30 (6): 459- 463. doi: 10.13201/j.issn.1001-1781.2016.06.010
9	Gil Z , Abergel A , Leider-Trejo L , et al. A comprehensive algorithm for anterior skull base reconstruction after oncological resections[J]. Skull Base, 2007, 17 (1): 25- 37. doi: 10.1055/s-2006-959333

相关文章 15

[1]	刘玉柱,苑铁君,李波. 会厌原发神经内分泌癌1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 97-100.
[2]	邱前辉,肖旭平,杨钦泰,叶菁,邓泽义,王德生,谭国林,蒋卫红,卢永田,唐隽,石照辉,邓晓聪,刘遗斌,王跃武,段传志,杜德坤,白小欣,陈文伙,莫立根,蔡楚伟,曾鹏,何旭英,杨一梅,赵洲洋,陈健龙,赵充,林志雄,李先明,李曙平,陈冬平,陈勇,黄莹,陈春燕,韩非,黄理金,瞿申红. 鼻咽癌治疗后并发颈动脉爆裂综合征的临床处理专家共识[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 1-18.
[3]	王再兴,唐志元,李定波,石照辉,曾宪海,张秋航. 鼻咽癌放疗后肿瘤复发及颅底骨坏死引起颈内动脉破裂的治疗方案[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 49-58.
[4]	朱瑞楷,吴家荣,孙芳,谢楚波,邱前辉. 基于计算机断层扫描血管造影术评估鼻咽癌放疗后引起颈内动脉狭窄状况及其影响因素的研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 77-84.
[5]	张剑利,陈伟雄,陈瑞开,邝德斌,庞艺施. 鼻咽癌放疗后远期吞咽功能的纤维喉镜评估[J]. 山东大学耳鼻喉眼学报, 2019, 33(6): 56-59.
[6]	黄纪逸,李柏滋,吴树浓,吕正华. 咽腭弓肌黏膜瓣闭合扁桃体等离子术后创面的临床疗效[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 92-95.
[7]	姜彦. 鼻咽癌复发及鼻内镜外科手术的应用[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 1-11.
[8]	陈冬平,杨致欢,张炎,方楠,齐斌. 复发鼻咽癌手术治疗地位的思考[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 12-16.
[9]	邱前辉,陈卓. 鼻内镜手术治疗首诊局部晚期鼻咽癌及放疗后严重并发症的作用[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 17-20.
[10]	王振霖,刘俊其. 鼻咽癌外科治疗中的颈内动脉保护[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 21-25.
[11]	陆海军,刘霁,丁晓. 鼻咽癌的综合治疗研究进展[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 26-30.
[12]	陈瑞,李杰恩. 鼻咽癌放疗后诱发头颈部恶性肿瘤的治疗[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 31-34.
[13]	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.
[14]	刘全,孙希才,于华鹏,赵可庆,张焕康,赵卫东,顾瑜蓉,李厚勇,王德辉,余洪猛. 鼻内镜下鼻咽癌切除术的手术分型[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 39-45.
[15]	赵丽娟,姜彦,于龙刚,蔡亮,陈敏,张继生,李志远,鞠建宝,李娜. 鼻咽癌内镜手术治疗临床分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 51-56.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed