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目的探讨鼻内镜技术联合鼻侧切开术治疗鼻腔鼻窦恶性肿瘤的可行性。方法 14例确诊为鼻腔鼻窦恶性肿瘤的病例,先行常规的或变通的鼻侧切开术切除大块肿物,同时联合应用鼻内窥镜技术对深在、隐蔽的、可疑肿瘤残余的部分(如筛顶、嗅裂、额隐窝、颅底及纸样板等处)在鼻内镜下以仔细的探查、打磨、烧灼等方式彻底切除肿瘤,必要时在内镜下修复颅底缺损及脑脊液漏,观察治疗效果。结果术后随访6个月~3年,横纹肌肉瘤1例复发,1例嗅神经母细胞瘤颅内侵犯复发并颈淋巴结转移,其中有2例死亡(1例腺样囊性癌复发肺转移死亡,1例黑色素瘤生存11个月发现颅内复发转移后死亡)。结论鼻内镜技术联合鼻侧切开术治疗位于前颅底的鼻腔鼻窦恶性肿瘤是可行的,它能弥补传统鼻侧切开术对颅底及隐蔽深在部位(如筛顶、嗅裂、上鼻道、翼腭窝、硬脑膜等处)不能清楚地观察,以致很难做到完整切除肿物的不足。
Objective To explore the feasibility of endoscopic sinus surgery combined with nasal incision in the treatment of nasal sinus cancer. Methods Fourteen cases diagnosed as malignant nasal sinus cancer were treated by conventional or modified nasal cystectomy for massive resection of the tumor. Combined with endoscopic sinus surgery, the remaining part of the deep, hidden and suspicious tumor Such as the top of the screen, olfactory fissures, frontal recess, skull base and paper model, etc.) under the endoscopic sinus with careful exploration, grinding, cauterization and other means of complete removal of the tumor, if necessary, in the endoscopic repair of skull base defects and cerebrospinal fluid Leakage, observe the effect of treatment. Results The patients were followed up for 6 months to 3 years. One case of rhabdomyosarcoma recurred, one case of recurrent intracranial invasion of olfactory neuroblastoma and cervical lymph node metastasis. There were 2 deaths (1 case of adenoid cystic carcinoma recurring lung metastasis and death , 1 case of melanoma survived 11 months after the discovery of intracranial recurrence and metastasis death). Conclusion Nasal endoscopic sinus surgery combined with nasal incision in the treatment of nasal sinus cancer located in the anterior skull base is feasible, it can make up for the traditional skull base and hidden deep in the site (such as the top of the screen, olfactory rupture, The nasal passages, pterygopalatine fossa, dura mater, etc.) can not be clearly observed, it is difficult to complete the lack of complete removal of the tumor.