外耳道完整切除术治疗早期外耳道癌的临床研究  

The study on the en bloc resection of the external auditory canal to treat external auditory canal carcinoma in the early stage

作　　者：于亚峰[1] 张茹[1] 戴春富[1] 

机构地区：[1]复旦大学眼耳鼻咽喉科医院耳神经颅底外科,上海200031

出　　处：《临床耳鼻咽喉头颈外科杂志》2009年第7期313-315,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：教育部新世纪优秀人才支持计划项目(No:NCET-06-0369);国家自然科学基金(No:30772398);国家科技部"十五"攻关资助项目(No:2004BA702B04)

摘　　要：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 introduce the en bloc resection of the external auditory canal. To improve early diagnosis and the effective surgical management of external auditory canal carcinoma. Method.. Twelve cases of the early stage external auditory canal carcinoma were reviewed retrospectively. All cases were undergone surgical treatment by en bloc external auditory canal resection plus lateral temporal bone resection and superficial parotidectomy. All the patients were followed up from 1 to 3 years. Result：There were 7 males and 5 females, age ranged from 28 to 75 years. According to T stage, there were 4 T1,8 T2. Eight cases complaint of otalgia or ear pain and 6 cases present with otorrhea. Among 6 otorrhea cases, 3 cases had bloody secretions. Mass with variable sizes in the external auditory canal could be identified by physical examination. Six cases were diagnosed by biopsy preoperatively, another 6 cases were diagnosed by mass resection pathologically. Postoperative pathological diagnosis revealed that 6 cases with adenoid cystic carcinomas, 5 cases of squamous cell carcinomas, 1 case of cerumianl adenocarcinoma. No lesion involved in parotid gland and lymphoids of parotid surface. Safety lateral incision margin was obtained and no lesion penetrated tympanic membrane in all cases. Five cases of squamous cell carcinomas, 1 case of cerumianl adenocarcinoma and 3 cases of adenoid cystic carcinomas received radiotherapy postoperatively. All pa- tients were alive free of carcinoma during the follow-up. Operation side in 6 cases present with incomplete facial paralysis immediately postoperatively and graded Ⅲ to Ⅳ by House-Brackmann Facial Nerve Grading System, which all fully recovered within 1-3 months. All cases showed conductive hearing loss after surgery. The preoperative average hearing threshold was 38dB （500,1000,2 000 Hz） while postoperative average hearing threshold of all cases was 65 dB（500,1 000,2 000 Hz）. One patient had parotid fistula after surgery and recovered by pressure packeting. Conc

关 键 词：外耳道肿瘤 诊断 外科手术 

分 类 号：R764.1[医药卫生—耳鼻咽喉科]