论文部分内容阅读
目的:提高早期外耳道癌诊断和手术治疗效果,介绍外耳道完整切除的手术方法。方法:回顾性分析12例早期外耳道癌的临床表现,所有患者均采用外耳道完整切除、颞骨侧切除和腮腺浅叶切除,随访1～3年。结果:男7例,女5例;年龄28～75岁,其中T14例,T28例。8例患者术前耳部疼痛或胀痛。6例患者术前有耳流水,其中3例患者有血性分泌物。查体外耳道可见大小不等的新生物,6例患者术前活检而被诊断,另6例以外耳道新生物为主诉,行外耳道肿块切除后病理确诊。术后病理诊断:腺样囊性癌6例,鳞状细胞癌5例,耵聍腺癌1例。腮腺组织和腮腺表面淋巴中未见有肿瘤累及,外切缘足够,向内未突破鼓膜。5例鳞状细胞癌,1例耵聍腺癌和3例腺样囊性癌患者术后接受放射治疗。所有患者在随访期间无瘤存活。有6例患者术后出现术侧不完全性面瘫,House-Brackmann评分为3～4级,均在术后1～3个月内完全恢复。12例患者术前平均听阈(500,1 000,2 000 Hz)为38 dB,术后平均听阈(500,1 000,2 000 Hz)为65 dB,均为传导性听力下降。1例患者术后出现腮腺涎漏,经加压包扎后痊愈。结论:及时的病理活检是诊断早期外耳道癌的关键。具有安全边缘的外耳道的完整切除是提高手术效果的有效途径。
Objective: To improve the diagnosis and surgical treatment of early external auditory canal, and to introduce the surgical method of complete resection of external auditory canal. Methods: The clinical manifestations of 12 cases of early external auditory canal cancer were retrospectively analyzed. All patients received complete resection of the external auditory canal, resection of the temporal bone and removal of the parotid gland lobectomy. The patients were followed up for 1 to 3 years. Results: There were 7 males and 5 females, ranging in age from 28 to 75 years old, including T14 cases and T28 cases. Eight patients had preoperative ear pain or tenderness. Six patients had auricle flow before surgery, of which 3 patients had bloody discharge. Examination of external auditory canal in the new size can be seen in different sizes, 6 patients were diagnosed preoperative biopsy, and the other 6 cases of external auditory canal mainly for new organisms, removal of external auditory canal massacre pathology. Postoperative pathological diagnosis: adenoid cystic carcinoma in 6 cases, squamous cell carcinoma in 5 cases, 1 case of adenoma. Parotid gland and parotid surface lymphoid tumor was not seen in the external margin of the margin enough, did not break the tympanic membrane inward. 5 cases of squamous cell carcinoma, 1 case of adenoma and 3 cases of adenoid cystic carcinoma received radiotherapy after surgery. All patients survived tumor-free during follow-up. There were 6 cases of incomplete facial paralysis after surgery, House-Brackmann score of 3 to 4, were fully recovered within 1 to 3 months after surgery. The mean preoperative hearing threshold (500, 1000, 2 000 Hz) was 38 dB in 12 patients. The mean hearing threshold (500, 1000, 2 000 Hz) after surgery was 65 dB, all of which were conductive hearing loss. One patient had parotid salivary gland leakage after operation and was healed after bandaging. Conclusion: Timely biopsy is the key to diagnosis of early external auditory canal cancer. The complete removal of the external auditory canal with safety margin is an effective way to improve the surgical effect.