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目的探讨经鼻内镜切除嗅神经母细胞瘤的疗效及辅助放射治疗的意义。方法对2001年8月至2005年9月经鼻内镜手术治疗的6例鼻腔鼻窦嗅神经母细胞瘤患者的临床特征、治疗效果及失败的原因进行回顾性分析。其中男4例,女2例;1例儿童,5例成人,年龄9～68岁;KadishB 期2例,C 期4例。所有病例随访14～63个月。结果 6例鼻腔鼻窦嗅神经母细胞瘤患者,5例肿瘤完全切除,包括1例先开颅手术,1例颅内侵犯经鼻内镜切除肿瘤并进行颅底修复,1例颈淋巴清扫术,1例次全切除。5例首次术后辅助放疗,均无瘤生存,1例未加放疗手术后复发带瘤生存至31个月死亡,中位生存期44.5个月。结论内镜手术具有手术进路简便,视野清晰,损伤小,术后恢复快,面部不留瘢痕,易为患者接受的优点。初步结果显示该术式是治疗鼻腔鼻窦嗅神经母细胞瘤的有效方法,但术后必须结合放射治疗方可获得满意效果。
Objective To investigate the efficacy of nasal endoscopic excision of olfactory neuroblastoma and the significance of adjuvant radiotherapy. Methods A retrospective analysis was performed on the clinical features, the therapeutic effects and the causes of failure of 6 patients with nasal sinuso-olfactory neuroblastoma treated by endoscopic sinus surgery from August 2001 to September 2005. There were 4 males and 2 females; 1 child, 5 adults, aged 9 to 68 years; 2 cases in KadishB and 4 cases in C. All cases were followed up for 14 ~ 63 months. Results Six patients with nasal or olfactory neuroblastoma were completely resected in five cases, including one case of craniotomy, one case of intracranial invasion of nasal endoscope and resection of skull base, one case of neck dissection, 1 case subtotal resection. In 5 cases, the first postoperative adjuvant radiotherapy did not have tumor-free survival. One case survived without tumor recurrence and survived to 31 months with a median survival time of 44.5 months. Conclusion Endoscopic surgery has the advantages of simple operation, clear vision, small injury, quick recovery after operation and no scar on the face, which is easy for patients to accept. Preliminary results show that the surgical treatment of nasal sinus is an effective method of olfactory neuroblastoma, but must be combined with radiotherapy after surgery to obtain satisfactory results.