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单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,研究背景,鼻咽癌首选放射治疗，放疗后单纯局部复发率约,10%,；,救援性外科治疗是局部复发鼻咽癌最佳治疗手段之一；,鼻咽切除术也是鼻咽腺癌、肉瘤等的治疗方法之一；,鼻外进路：空间大但创伤大,鼻内进路：微创但空间狭窄,外科切除：广泛切除但操作难度大,消融治疗：操作简便但适应症狭窄,？,Endoscopic,surgery,Oncological,Endoscopic,nasopharyngectomy,Conventional open surgery,经鼻内镜鼻咽切除术,rNPC,T2bN0M0,a,b,c,C,B,A,Pre-Op,Post-Op,手术前后,MRI,对比,手术前后,MRI,对比,结果,1,N=67,Male:female,15,male,52,Radiotherapy:one circle,53,two circles,14,rT,stages(UICC2002):rT1,27,rT2a,7,rT2b,22,rT3,11,Median age,years(range),49(2771),From Oct 2004 to Jan 2010 with median follow-up 28 months(468 m),From Oct 2004 to June 2009 with median follow-up 31 months(668 m),生存曲线,Surgical approach,n,Op,time(min),Blood,loss(ml),Post-op hospital stay(d),Ectro-pion,Nerve,tran,-section,Palatal fistula,trismus,Impaired swallow-,ing,Nasal,regurg-itation,Others,Chen MY,1,Transnasal,with endoscopy,37,195,117,5,0,0,0,-,0,0,8,a,Willard EF,2,Tanspalatal,Transcervic,Transmaxilla,15,270,1072,7.9,-,3,-,-,1,-,4,37,300,981,6,4,5,10,To EW,3,Transnasal,with SNG,15,185,917,11,0,0,0,0,1,2,Maxilla swing,12,240,1398,32,9,6,3,4,2,5,3,Mandibular,swing,5,387,1596,54,0,3,1,2,1,1,maxilla and,mandibular,3,585,1270,63,2,2,0,3,2,1,a:,secretory,otitis,media,Chen MY,et al.Endoscopic,nasopharyngectomy,for locally recurrent nasopharyngeal carcinoma.Laryngoscope 2009;119(3):516-522,Willard EF,et al.,Nasopharyngectomy,for recurrent nasopharyngeal cancer:a 2-to 17-year follow-,upJ,.,Arch-,Otolaryngol-Head-Neck-Surg,2002,128(3):280-284.,To EW,et al.The use of,stereotactic,navigation guidance in minimally invasive,transnasal,nasopharyngectomy,:,a comparison with the conventional open,transfacial,approachJ,.Br-J-Radiol,2002,75(892):345-350.,与鼻外进路鼻咽切除术的对比,Group 1,（,N=18,）,Group 2,（,N=18,）,P Value,Gender:female,3,4,male,15,14,0.317,rT,stages(UICC2002):rT1,9,9,rT2a,1,1,rT2b,8,8,1.0,Radiotherapy:one circle,13,13,two circles,5,5,1.0,Age(years):,49.313.4,48.88.7,0.931,Healing Time(weeks),13.16.5,26.327,0.016,From Oct 2004 to June 2009 with median follow-up 31 months(668 m),结果,2,：中鼻甲粘膜瓣修复效果,第三部分：,外科治疗非鳞癌初治鼻咽恶性肿瘤,放化疗不敏感的病理类型或患者拒绝放射治疗,鼻咽肿瘤范围局限，无淋巴结和远处转移,充分的知情同意和良好的随访条件,多学科专家会诊共同制定治疗计划,结果,3:,单纯外科治疗鼻咽恶性肿瘤,Pathologic,Dignosis,N=77,T stage,Follow-up,Result,Local recurrent NPC:,Newly non-metastasis NP malignancies:,carcinoma in situ,Adenocarcinoma,Sarcoma,Adenoid cystic carcinoma,Extramedullary,plasmacytoma,Spindle cell,hemangieoendothelioma,Hemangiopericytoma,67,10,2,2,2,1,1,1,1,Tis,T1,T2a,T1,T3,T1,T1,T3,T2b,28(468),32(858),28,48,14,58,8,15,47,40,32,34,ADF,in Pa,ADF(both),ADF(both),ADF,*,ALP,*,DLR,ADF,ADF,ALP,ADF,：,alive and disease free;ALP,：,alive with local persistence;ALR,：,alive with local recurrence;DLR:dead of local,recurrece,;,*,post-operational radiotherapy.,中山大学肿瘤医院 陈明远,SYSUCC Ming-Yuan Chen,创新的经鼻内镜鼻咽切除术治疗,rT1/T2a,和选择后,rT2b/T3,期局部复发鼻咽癌微创、安全并且有效,;,创新的带血管蒂鼻腔粘膜瓣能有效而微创地修复局部复发鼻咽癌的手术创面；,基于经鼻内镜鼻咽切除术的单纯外科治疗，为部分,拒绝放射治疗,的,高选择后,的非鳞癌初治鼻咽恶性肿瘤患者提供一个新的备选治疗方法。,结论,致谢！,致谢：,中山大学肿瘤防治中心鼻咽科郭翔、钱朝南、李宁炜、曹卡加、麦海强、邓满泉、莫浩元、郭灵、邱枋、向燕群、黄培钰、罗东华、陈秋燕、孙蕊等全体同事；,中山大学肿瘤防治中心放疗科卢泰祥、刘孟忠、马俊、赵充、罗伟、吴少雄、胡伟汉、谢方云、苏勇、卢丽霞、韩非、孙颖、曹新平、李群、刘慧等全体同事；,中山大学肿瘤防治中心头颈外科杨安奎、李浩、刘学奎、陈伟超等全体同事；,中山大学肿瘤防治中心神经肿瘤科陈忠平、牟永告等全体同事；,中山大学肿瘤防治中心影像科谢传淼教授、核医学科樊卫教授等；,中山大学附属第一医院耳鼻喉科文卫平、李添应教授等；,香港大学玛丽医院韦霖教授、陈汝威医师等；,荷兰癌症中心列文虎克医院头颈肿瘤科,Bing Tang,教授、,Geerten,医师；,谢谢大家！,课题组：,中山大学肿瘤防治中心鼻咽科：洪明晃教授、华贻军、万香波、朱玉亮等。,
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