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題 名 | 上頜掀開術切除局部復發之鼻咽癌--三例報告=Maxillary Swing Approach for Resection of Recurrent Nasopharyngeal Carcinoma--Report of Three Cases |
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作 者 | 劉時安; 許振益; 江榮山; 林進清; | 書刊名 | 中華民國耳鼻喉科醫學雜誌 |
卷 期 | 34:1 民88.01-02 |
頁 次 | 頁71-74 |
分類號 | 416.879 |
關鍵詞 | 復發性鼻咽癌; 上頜掀開術; 外科處理; Recurrent nasopharyngeal carcinoma; Maxillary swing; Surgical management; |
語 文 | 中文(Chinese) |
中文摘要 | 由於放射線治療效果良好,因此目前鼻咽癌的治療方式仍以放射線治療為第一優 先。但是對於復發性的鼻咽癌,再次的放射治療便有諸多爭議,這是因為:1)患者對放射治 療之敏感度較差,所以再治療效果欠佳。2)鼻咽周邊正常組織之傷害。3)神經學方面的後遺 症。本科於民國86年3月至7月經歷3個確認局部復發性鼻咽癌病例,經電腦斷層、腹部超音 波、胸部X光、以及核醫全身骨骼掃描,確定局限於鼻咽腔後,入院接受〞上頜掀開術〞, 成功地切除鼻咽腔腫瘤。復發病人年齡由34至60歲不等,3例全為男性,第1次治療到復發的 期間由2年7個月至12月1估月,術後病理報告均為類上皮細胞癌;臉上傷口癒合良好,無術 後感染,也無上頜骨壞死之現象和口鼻�硎犑峖芋A亦無明顯牙關緊閉之情形,門診追蹤至今 已至少12個月尚無復發情形。對於治療只局限在鼻咽腔之復發性鼻咽癌,〞上頜掀開術〞, 合併症少,且可由頭頸外科大夫獨力完成,此手術法頗富潛力,唯其治療效果仍待較長期之 追蹤。 |
英文摘要 | As nasopharyngeal carcinoma (NPC) is rather radio-sensitive, radiotherapy has been the treatment of choice in all new patients with NPC. However, the use of further radiation for a recurrent tumor is debatable due to (1) an unsatisfac- tory outcome, (2) demage to the surrounding tissue, and (3) neurological sequelae (radiation myelitis, encephalopathy, cranial nerve palsy, etc.). We present our experience with the maxillary swing approach to extirpate recurrent NPC confined to the nasopharynx. Three patients with recurrent NPC underwent radical excision using the maxillary swing approach from March 31, 1997 to July 23, 1997. First, a Weber- Fergussen incision was made. Then the maxilla was freed and rotated to the lateral side. The nasopharynx became visible and the tumor was resected under direct vision. The age of the patients ranged from 34 to 76 years and all were men. The duration of time from initial radiation treatment to recurrence ranged from 31 months to 145 months. All resected tissues were proven to be epidermoid carcinoma by pathological examination, whereas all cut margins were noted to be free of tumor. There was no mortality. The average hospitalization time was short. The facial wounds healed primarily without necrosis of the maxilla. No palatal fistula nor definite trismus was noted during out patient follow up for at least 12 months. In conclusion, the maxillary swing approach may be a potential altermative treatment modality which can be used for recurrent NPC confined to the nasopharynx. It can be performed by a head and neck surgeon with a good outcome. |
本系統中英文摘要資訊取自各篇刊載內容。