Objective: To summarize the clinical experience and treatment results of endoscopic transoral resection of metastatic retropharyngeal lymph nodes (MRPLN) in nasopharyngeal carcinoma (NPC) via posteroinferior eustachian tube approach. Methods: The clinical data of 37 patients with NPC who underwent endoscopic transoral surgery via posteroinferior eustachian tube approach for MRPLN in Xuanwu Hospital, Capital Medical University from 2010 to 2020 were analyzed retrospectively. There are 28 males and 9 females, aged from 31 to 72 years. The clinicopathological features such as gender, age, primary tumor stage, stage, side and size of MRPLN were recorded and analyzed. The surgical procedures of endoscopic transoral resection of MRPLN via posteroinferior eustachian tube approach were described. The MRPLN resection, perioperative complications and follow-up results were also summarized. Results: The primary tumors of 37 cases were determined as rT1 stage in 2 cases, rT2 stage in 30 cases and primary T2 stage in 5 cases in this study. There were 33 cases of unilateral MRPLN(89.2%), 4 cases of bilateral ones (10.8%), 36 cases in N1 stage, and 1 case in N3 stage. Single lymph node was detected in 23 cases(62.2%), and 2-5 lymph nodes in 14 cases(37.8%). Endoscopic transoral surgery via posteroinferior eustachian tube approach was completed in all cases. Total MRPLN resection was obtained in 35 cases (94.6%) with one-stage operation, and subtotal resection was achieved in 2 cases whose MRPLN involved the wall of internal carotid artery. No serious complications occurred in the perioperative period. During the follow-up period (median follow-up period 53.1 months), no recurrence of MRPLN was observed in patients who received total resection. And 8 patients (21.6%) died from different causes. Conclusion: Endoscopic transoral surgery via posteroinferior eustachian tube approach for MRPLN is a practicable and effective surgical option, but the long-term effect still needs longer follow-up and summary of bulk cases.
目的： 总结内镜经口咽鼓管后下入路切除鼻咽癌咽后转移淋巴结的手术效果和临床经验。 方法： 回顾性分析2010—2020年于首都医科大学宣武医院采用内镜经口咽鼓管后下入路对咽后转移淋巴结进行手术治疗的37例鼻咽癌患者的临床资料，其中男性28例，女性9例，年龄31~72岁。记录分析其性别、年龄、原发肿瘤分期、咽后转移淋巴结分期、侧别和大小等临床病理特点。描述内镜经口咽鼓管后下入路切除鼻咽癌咽后转移淋巴结的手术方法。总结咽后转移淋巴结的切除情况、围手术期并发症及随访结果。 结果： 本组37例患者的原发肿瘤判定为rT1期2例，rT2期30例，初发T2期5例。单侧咽后淋巴结转移者33例（89.2%），双侧咽后淋巴结转移者4例（10.8%）；N1期36例，N3期1例；单个淋巴结转移者23例（62.2%），2~5枚淋巴结转移者14例（37.8%）。所有病例均完成了内镜经口咽鼓管后下入路咽后淋巴结切除术，一期手术获得全切35例（94.6%），2例侵犯颈内动脉壁者完成了次全切除。围手术期未发生严重并发症。在随访期间（中位随访时间53.1个月），获得全切者未观察到咽后淋巴结复发，8例（21.6%）患者因不同病因死亡。 结论： 内镜经口咽鼓管后下入路鼻咽癌咽后转移淋巴结切除术是一种可行、有效的手术治疗方式，其远期疗效仍需大宗病例的随访和总结。.