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2000, vol. 39, br. 5, str. 47-52
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Hirurška terapija malignih tumora nosa i sinusa sa kratkim osvrtom na naš bolesnički materijal
Surgical therapy of the malign tumors of the nose and the sinus with a brief review of our patient material
Klinički centar Niš, Klinika za bolesti, uva, grla i nosa
Keywords: malign tumors; nose; sinus; principles of the surgical therapy
Sažetak
Maligni tumori nosa i paranazalnih sinusa se obično prepoznaju u odmakloj fazi bolesti kada dođe do erozije koštanih zidova, pa je stepen petogodišnjeg preživljavanja manji od 50%. Limfna drenaža je usmerena ka submandibularnim, parotidnim i jugulodigastričnim limfnim čvorovima. Ovi tumori retko daju metastaze vrata i udaljene metastaze, ali je zato propagacija u okolne vitalne strukture glave česta i glavni je uzrok smrtnog ishoda. Najčešći tumor paranazalnih sinusa je u maksilarnom sinusu, a zatim, u etmoidnom labirintu i šupljini nosa. Histološki se najčešće radi o planocelularnom karcinomu (oko 80), dok su ostali tipovi ređi. Osim u početnom stadijumu, maligni tumori paranazalnih sinusa leče se kombinovanom hirurškom i radioterapijom. Primarno se obavlja radikalna hirurška intervencija na koju se nadovezuje radioterapija. Vreme između operacije i radioterapije treba maksimalno skratiti zbog ustanovljeno loših rezultata u slučaju produženja ovog intervala. Zahvatanje baze lobanje, kavernoznog sinusa, pteroigoidnog prostora, nazofarinksa i inoperabilne žlezde vrata predstavljaju relativnu kontraindikaciju za hirurško lečenje. U nekim slučajevima potrebna je enukleacija orbite ili kombinovani kraniofacijalni pristup u cilju odstranjenja tumora. Recidivi bolesti, nezavisno od toga da li je terapija hirurška ili radioterapija nastaju u prve dve godine.
Abstract
The malign tumors of the nose and of the paranasal sinus are usually recognized only at an advanced stage of the disease when the bone walls get eroded thus making a five years period of survival less than 50%. The lymph drainage is directed towards the submandibular, parotid and jugudigastric lymph nodes. Such tumors rarely give netastases of the neck as well as distant ones; however, their spawning to the surrounding vital structure of the head is frequent and it is the main cause of the lethal outcome. The most frequent tumor of the paranasal sinus is in the maxillary sinus followed by the one in the elhmoid labyrinth and the nose hollow. Regarding histology, the most frequent is the planocellular carcinoma (about 80) while the other types are less frequent. Except in the intial stadium, the malign tumors of the paranasal sinuses are treated by the combined surgical and radiotherapy. The radical surgical intervention is first done later to be completed by the radiotherapy. The time between the operation and the radiotherapy should be maximally reduced due to the established bad results in the cases when this time interval was prolonged. The propagation in the skull base, the cavernous sinus the pterygoid space, the nasopharynx and the inoperable neck nodes can be a relative counterindication for the surgical treatment. In some cases it is necessary to add the enucleation of the orbit or the combined craniofacial approach for the sake of removing the tumor. The disease recessives, regardless of whether the therapy was surgical of radiotherapy, occur in the first two years.
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