外耳道腺样囊性癌诊治体会.docVIP

外耳道腺样囊性癌诊治体会【摘要】 目的 提高外耳道腺样囊性癌的诊疗水平。方法 回顾性分析10例外耳道腺样囊性癌的临床资料。复习相关文献并作综合分析。结果 所有患者均得到以手术切除为主的综合治疗,随访时间2～17年。术后复发4例,死亡2例,临床治愈4例。结论 外耳道腺样囊性癌不易早期确诊,有必要对此病提高警惕。以手术治疗为主的综合治疗成为目前主要治疗手段。由于肿瘤境界不清,如何达到彻底切除值得探讨。? 【关键词】腺样囊性癌；耳肿瘤；综合治疗 ? Diagnosis and therapy experience of adenoid cystic carcinoma of external auditory canal XU Yuan-teng,LIN Gong-biao,LIN Chang，et al.Department of Otolarygology Head and Neck Surgery，the First Affiliated Hospital of Fujian Medical University，Fuzhou,Fujian 350005，China ? 【Abstract】 Objective To detect the method of the diagnosis and treatment of adenoid cystic carcinoma of external auditory canal(ACCEAC).Methods A retrospective analysis was performed on 10 patients with ACCEAC by the clinical performance，the therapy，and the follow-up results as well as the combination with the review of related literature.Results All patients were treated by the comprehensive treatment which is main of surgical excision，and followed up from 2~17 years.4 of them recrudescence，2 of them died after operation，and 4 of them have obtained the clinical cures.Conclusions More attention should be paid to ACCEAC，which is not easy to exact diagnosis in early stage.It becomes the main treatment method to have the Comprehensive Treatment which is main of surgical excision.And it’s necessary to discuss how to do thoroughly excision because of tumor fuzzy boundary.? 【Key words】Adenoid cystic carcinoma；Ear neoplasm；Comprehensive treatment ? 腺样囊性癌(adenoid cystic carcinoma，ACC)是一种低度恶性肿瘤，又称圆柱瘤、圆柱瘤型腺癌，较为少见，可发生于各种涎腺、泪腺、上消化道（口腔、腭、颊黏膜、舌及咽部），呼吸道（鼻腔、鼻窦、喉、气管及肺部）等处。ACC既有圆柱瘤特性又有侵犯神经和沿神经分布的特点，生长缓慢，症状不典型且持续多年，易复发。ACC原发于外耳道者罕见，且容易误诊。为提高对本病的认识和诊治水平，现将本院1981-2006年共收治的10例外耳道腺样囊性癌作一报告，并就有关问题进行讨论。? 1 资料与方法? 1．1 临床资料 本组患者10例，男1例，女9例：年龄25～60岁，平均46．8岁。从出现症状到确诊时间平均为4．5年(6个月～10年)。其中6例以长期间断或持续性耳痛首诊，4例以耳道内肿物首诊。1例侵犯咽旁间隙，2例出现耳漏、耳闷和听力下降；2例侵犯腮腺；1例出现面瘫；2例侵犯颅底；1例颈部淋巴结肿大及远处转移；2例有院外手术史，其中4次手术者1例，8次手术者1例，均为局部复发。专科检查发现，肿瘤全部位于外耳道软骨部，其中位于外耳道底壁的5例，后壁的4例，前下壁受累1例；肿瘤质韧至较硬，有触痛者6例。? 1．2 诊断