术中液氮冷冻加术后放疗在治疗腮腺癌保留面神经中的应用  

Cryotherapy and postoperative radiotherapy-assisted surgery with preservation of the facial nerve for treatment of malignant parotid gland tumors

作　　者：石钿印[1] 彭歆[1] 蔡志刚[1] 俞光岩[1] 

机构地区：[1]北京大学口腔医学院口腔颌面外科,100081

出　　处：《现代口腔医学杂志》2011年第1期7-11,共5页Journal of Modern Stomatology

基　　金："十一五"国家科技支撑计划课题(2007BAI18B14)

摘　　要：目的研究手术联合术中液氮冷冻和术后放疗治疗面神经与肿瘤紧贴的腮腺癌能否达到既局部控制肿瘤、又保留面神经功能的效果。方法分析9例采用手术联合术中液氮冷冻、术后放疗治疗腮腺癌保留面神经患者的临床病理资料,对患者进行2～19年的随访,平均随访时间9年,观察局部有无肿瘤复发。8例患者行House-Brackmann系统(HB系统)面神经功能评价,7例患者行神经电图(ENoG)检测,评估面神经功能恢复效果。结果在随访期间,9例患者中1例肿瘤复发伴颈淋巴结转移,行再次手术治疗,在首次治疗后6年无瘤生存。其余8例患者原发灶均无复发。6例患者分别在首次术后7年(2例)、10年、11年、15年、19年无瘤生存。2例患者分别于术后2年和2.5年死于肺心病和肺转移。8例患者面神经功能均得到恢复,4例达HBⅠ级,2例为HBⅡ级,2例为HBⅢ级。ENoG检查的7例患者的面神经各分支均能引出电生理反应。结论对于面神经与癌瘤紧贴,但可在完整切除癌瘤的前提下分离保留面神经的腮腺癌患者,当缺乏125I放射性粒子植入或192Ir后装组织内近距离放射治疗的条件时,手术联合术中液氮冷冻和术后放射治疗是可行的综合治疗方案。Objective To study the effect of surgery combined with cryotherapy and postoperative radiotherapy for preservation of the facial nerve which directly contacts to the malignant parotid gland tumors.Methods The clinical and pathological data of 9 cases treated by cryotherapy and postoperative radiotherapy-assisted surgery for preservation of the facial nerve which directly contacted to the malignant parotid gland tumors were reviewed and analyzed. All patients were followed up for 2 to 19 years with a mean of 9 years. The recovery outcome of facial nerve function was evaluated with the House-Brackmann Grading System （HB grading system） in 8 patients. Electroneurography was carried out in 7 patients.Results During follow-up of the 9 cases, one case had local recurrence, who also developed metastasis to the cervical lymph nodes. The patient was cured by reoperation and was alive without disease 6 years after the first treatment. There was no local recurrence in the rest 8 cases. Six patients were alive without recurrence of tumor 7 （2 cases）, 10, 11, 15 and 19 years after combined treatment respectively. One patient was died of pulmonary metastasis 2.5 years postoperatively, and another was died of pulmonary heart disease 2 years postoperatively. Facial nerve function of the 8 patients had all recovered. Four cases recovered to HB gradeⅠ, two to HB grade Ⅱ, and two to HB grade Ⅲ. Electrophysiologic response could be detected in the facial nerve of all 7 patients.Conclusion In this study, preservation of the facial nerve which directly contacts to the malignant tumor of the parotid gland by surgery combined with cryotherapy and postoperative radiotherapy is practicable.

关 键 词：腮腺癌 手术 液氮冷冻 放射治疗 面神经 功能评价 

分 类 号：R739.8[医药卫生—肿瘤]