CAJ | 학술논문

目的探讨外耳道腺样囊性癌的治疗方法与影响预后的相关因素.方法对解放军总医院耳鼻咽喉头颈外科医院1988--2004年收治的19例外耳道腺样囊性癌患者的临床资料进行分析.依据Pittsburgh外耳道癌分类法,T1期5例,T2期2例,T3期6例,T4期6例.T1和,12期病例行局部切除,T3和T4期病例行乳突根治术或颞骨切除术.术后予以足量放疗.复发病例伴远处转移单灶者行手术治疗,远处多灶转移者行放疗.结果 19例病例术后随访时间6个月～19年,随访时间中位数44个月,随访5年以上者8例.12例复发,7例远处转移,4例死亡.初次切缘肿瘤细胞阳性的4例患者足量放疗后全部复发.复发患者有9例进行了2次以上手术治疗,8例进行了3次以上手术治疗,4例进行了4次手术治疗.结论外耳道腺样囊性癌起病隐匿,易复发,可长期带瘤生存.首次手术应扩大切除范围,确保切缘肿瘤细胞阴性.术后辅以足量放疗.复发病例可多次手术治疗,延长生存期.多次局部复发后易发生远处转移.远处转移是主要死亡原因.
목적 탐토외이도선양낭성암적치료방법여영향예후적상관인소.방법 대해방군총의원이비인후두경외과의원1988--2004년수치적19예외이도선양낭성암환자적림상자료진행분석.의거Pittsburgh외이도암분류법,T1기5례,T2기2례,T3기6례,T4기6례.T1화,12기병례행국부절제,T3화T4기병례행유돌근치술혹섭골절제술.술후여이족량방료.복발병례반원처전이단조자행수술치료,원처다조전이자행방료.결과 19례병례술후수방시간6개월～19년,수방시간중위수44개월,수방5년이상자8례.12례복발,7례원처전이,4례사망.초차절연종류세포양성적4례환자족량방료후전부복발.복발환자유9례진행료2차이상수술치료,8례진행료3차이상수술치료,4례진행료4차수술치료.결론 외이도선양낭성암기병은닉,역복발,가장기대류생존.수차수술응확대절제범위,학보절연종류세포음성.술후보이족량방료.복발병례가다차수술치료,연장생존기.다차국부복발후역발생원처전이.원처전이시주요사망원인.
Objective To explore methods of treatment for adenoid cystic carcinoma of external auditory canal, and discuss the correlating factors that effect prognosis. Methods A retrospective analysis of 19 cases of adenoid cystic carcinoma of external auditory canal treated from 1988 to 2004 was carried out. Based on University of Pittsburgh TNM staging system of external auditory canal carcinoma, 19 cases were classified into groups as 5 cases in T1, 2 in T2, 6 in T3, and 6 in T4. Local resection was performed in cases in stage T1 and T2, while radical mastoidectomy or temporal bone resection was performed in stage T3 and T4. Radiotherapy was applied after operation. Relapsed cases with isolated metastasis were treated by surgery. Multiple metastasis were treated with radiotherapy. Results The follow-up time is from 6 months to 19 years, and the median is 44 months. There're 8 cases with more than 5 years' follow-up. Twelve patients relapsed and 7 had metastasis but 4 died. The cases with positive incisal edge after first operation relapsed even treated with radiotherapy. In recurrent cases, 9 cases received more than 2 operations, 8 more than 3, and 4 received 4 operations. Conclusions The adenoid cystic carcinoma of external auditory canal grows insidiously, and relapses frequently. But the patients can live long with neoplasm implanted. A wide surgical excision combined with post operative radiotherapy was proposed, and negative incision edge should be confirmed. Recurrent cases can be treated with several operations to elongate survival. Multiple relapses will cause metastasis more frequently. Metastasis is the main reason to cause death.