颞骨次全切除术治疗外耳道腺样囊性癌疗效分析

The efficacy analysis of subtotal temporal bone resection for adenoid cystic carcinoma of external auditory canal

摘要:

目的 探讨颞骨次全切除术在外耳道腺样囊性癌的临床应用效果。方法 回顾性分析我科2015—2019年经治的8例外耳道腺样囊性癌患者的临床资料：男性2例，女性6例，年龄33~76岁，平均年龄55.6岁；耳痛7例，外耳道肿块、耳溢液、听力下降各6例，面瘫1例；从最初出现症状到确诊平均为2.75年，5例曾被误诊，3例曾被误治手术；6例行颞骨次全切除+腮腺浅叶切除术，2例行颞骨次全切除+全腮腺切除术。 结果 围手术期内1例患者出现局部切口感染，1例出现脑脊液漏。全部患者平均随访4.34年；6例患者无瘤存活；1例复发患者于我院二次手术后3年再次出现局部复发伴肺转移，接受放射治疗，目前带瘤生存；1例患者术后随访3.5年死于其他疾病。结论 外耳道腺样囊性癌早期症状不典型，容易误诊；确诊后应实施颞骨次全切除术以达到彻底切除肿瘤目的，术中应同时处理腮腺；术后放疗也是一种可选择的补充治疗手段。

Abstract:

Objective：To investigate the clinical effect of subtotal temporal bone resection in adenoid cystic carcinoma of external auditory canal. Methods：8 patients with adenoid cystic carcinoma of external auditory canal treated in our department from 2015 to 2019 were retrospectively analyzed, including 2 males and 6 females, aged 33-76 years, with an average age of 55.6 years. 7 cases had earache, 6 cases was found mass in the external auditory canal , 6 cases had ear discharge, 6 cases had hearing loss, and only one case had facial paralysis. The mean time from the first symptom to diagnosis was 2.75 years. 5 cases had been misdiagnosed and 3 cases had been mistreated. Six patients underwent subtotal temporal bone resection and superficial parotid gland resection, and two patients underwent subtotal temporal bone resection and total parotid gland resection. Results：During the perioperative period, local incision infection occurred in one case and cerebrospinal fluid leakage occurred in one case. The mean follow-up was 4.34 years. Six patients survived without cancer. One recurrent patient developed local recurrence with pulmonary metastasis 3 years after the second operation in our hospital. And she received radiotherapy, and now living with tumor. One patient died of other diseases during 3.5 years of follow-up. Conclusion: The early symptoms of adenoid cystic carcinoma of external auditory canal were not typical and easy to be misdiagnosed. The subtotal temporal bone resection is performed to achieve complete resection of the tumor. And the parotid gland should be treated at the same time. Postoperative radiotherapy is also an alternative complementary therapy.