摘要
调强放疗(IMRT)技术的应用显著提高了鼻咽癌(NPC)患者的总体生存率和局部控制率,但仍有10%左右的局部复发率,而再程放疗可能引起严重的并发症.近年来,内镜手术成为复发性NPC的主要外科治疗方案,然而复发性NPC病变部位复杂且危险,尚未形成外科治疗的专家共识,复发性NPC手术仍是鼻颅底外科的重大挑战和重要议题.本文将从内镜手术对复发性NPC的疗效、局部淋巴结复发的手术方式、新的手术T分期和内镜手术分型、术后切缘阳性处理策略、颈内动脉处理方案、颅底修复手段、可切除标准的重新定义、放射性鼻颅底坏死的治疗以及原发性NPC外科治疗的思考等方面作一综述,并对NPC外科治疗的发展方向进行展望.
Abstract
The application of intensity-modulated radiation therapy(IMRT)has significantly improved the over-all survival and local control rates for patients with nasopharyngeal carcinoma(NPC).However,there remains a local recurrence rate of approximately 10%,with salvage radiation therapy potentially leading to severe complica-tions.In recent years,endoscopic surgery has become the primary surgical treatment for recurrent NPC.Nonethe-less,the lesion sites of recurrent NPC are complex and risky,and there has yet to be an established expert consen-sus on surgical treatment strategies.Surgery for recurrent NPC continues to present significant challenges and is a critical topic within skull base surgery.This article will review several aspects of surgical treatment for NPC,in-cluding the efficacy of endoscopic surgery for recurrent NPC,surgical approaches for local lymph node recur-rence,new surgical T staging and endoscopic surgery classification,strategies for managing positive surgical mar-gins post-operation,internal carotid artery management protocols,skull base reconstruction methods,the redefini-tion of criteria for resectability,the treatment of radiation-induced necrosis of the skull base,and reflections on the surgical treatment of primary NPC.Additionally,it will provide insights into the future directions of surgical treatment for NPC.
基金项目
中国医学科学院医学与健康科技创新工程项目资助(2019-I2M-5-003)
上海市科学技术委员会科技创新行动计划临床医学项目资助(19411950600)
上海市卫生健康委员会面上项目资助(201940143)
上海市科学技术委员会生物医药处西医引导项目资助(20Y11902000)
维普
万方数据