目的:嗅神经母细胞瘤(ONB)是一种罕见的鼻腔恶性肿瘤。手术一直是并且仍然是这种肿瘤患者的主要治疗方法。数十年来,开放式颅面切除术一直是首选治疗方法。最近,在ONB患者的治疗中,内镜方法的经验越来越多。这项研究的目的是报告作者在过去11年中使用单纯鼻内内镜技术治疗ONB患者的经验。
方法:作者对2006年1月至2017年1月在其机构接受完全经鼻内镜手术切除肿瘤的20例ONB患者进行了回顾性分析。患者人口统计学,肿瘤分期,病理分级,冰冻切片分析,永久保证金评估,围手术期并发症,术后治疗,随访时间,收集并分析末次随访时的结局.
结果:18例新诊断的患者,在2例中使用A的改良Kadish阶段,B在3中,C在11中,D在2中。两名患者出现复发性肿瘤。通过冰冻切片分析检查每位患者平均25.3个样本。尽管术中冰冻切缘分析在除1例外均为阴性,永久性组织病理学分析发现7例(35%)肿瘤的显微病灶。7例患者(35%)发生了围手术期并发症,其中1例发生了脑脊液漏;没有脑膜炎发作。除1例患者外,所有患者均接受术后放疗,5例患者接受术后化疗。平均随访超过5年,19例患者存活,1例死于无关原因。肿瘤复发2例。5年总体来说,疾病特异性,无复发生存率为92.9%,100%,和92.9%,分别。
结论:目前的结果为继续使用内镜手术治疗这种恶性肿瘤提供了额外的证据。
Olfactory neuroblastoma (ONB) is a rare malignant neoplasm of the sinonasal cavity. Surgery has been and remains a mainstay of treatment for patients with this tumor. Open craniofacial resections have been the treatment of choice for many decades. More recently, experience has been growing with endoscopic approaches in the management of patients with ONB. The object of this study is to report the authors\' experience over the past 11 years with ONB patients treated with purely endonasal endoscopic techniques.
The authors performed a retrospective chart review of 20 consecutive patients with ONB who underwent a completely endonasal endoscopic approach for an oncological tumor resection at their institution between January 2006 and January 2017. Patient demographics, tumor stage, pathological grade, frozen section analysis, permanent margin assessment, perioperative complications, postoperative therapy, length of follow-up, and outcomes at last follow-up were collected and analyzed.
Eighteen patients presented with newly diagnosed disease, with a modified Kadish stage of A in 2 cases, B in 3, C in 11, and D in 2. Two patients presented with recurrent tumors. An average of 25.3 specimens per patient were examined by frozen section analysis. Although analysis of intraoperative frozen section margins was negative in all but 1 case, microscopic foci of tumor were found in 7 cases (35%) on permanent histopathological analysis. Perioperative complications occurred in 7 patients (35%) including 1 patient who developed a cerebrospinal fluid leak; there were no episodes of meningitis. All but 1 patient received postoperative radiotherapy, and 5 patients received postoperative chemotherapy. With a mean follow-up of over 5 years, 19 patients were alive and 1 patient died from an unrelated cause. There were 2 cases of tumor recurrence. The 5-year overall, disease-specific, and recurrence-free survival rates were 92.9%, 100%, and 92.9%, respectively.
The current results provide additional evidence for the continued use of endoscopic procedures in the management of this malignancy.