CAJ | 학술논문

目的：探讨外耳癌的临床特点、手术方法及预后。方法回顾性分析36例外耳癌的诊疗资料，其中耳廓癌13例，外耳道癌23例。11例耳廓癌行肿瘤局部切除，2例耳廓癌行部分或全耳廓切除＋外耳道切除＋腮腺切除及颈部淋巴结清扫术；1例Tis及4例T1外耳道癌患者行肿瘤局部切除，5例T1患者行外耳道软组织袖状切除；6例T2患者行外耳道软组织及骨壁整块切除＋乳突切除术，如肿瘤侵犯外耳道周围软组织则加行腮腺浅叶切除；3例T3患者行颞骨外侧切除术＋腮腺切除＋腮腺区、颈Ⅰ～Ⅴ区淋巴结清扫；4例 T4患者行颞骨次全切除＋腮腺切除＋下颌关节切除术＋腮腺区、颈Ⅰ～Ⅴ区淋巴结清扫，创面以耳前带蒂皮瓣、耳后带蒂皮瓣、颞肌瓣、游离组织瓣修复。结果所有患者术后均未出现伤口延期愈合或皮瓣坏死情况。术后88．89％（32／36）的患者在不同程度上保留了患侧听功能，但晚期患者行放射治疗后，听力损失加重。随访5年，13例耳廓癌失访3例，无复发病例，仅1例因肺转移死亡；23例外耳道癌失访5例，8例复发，3年生存率77．78％（14／18）。结论耳廓癌早期易发现并彻底切除，预后较好；外耳道癌起病隐匿，早期易误诊，手术治疗越早，预后越好，术后听功能保存率高。
목적：탐토외이암적림상특점、수술방법급예후。방법회고성분석36예외이암적진료자료，기중이곽암13례，외이도암23례。11례이곽암행종류국부절제，2례이곽암행부분혹전이곽절제＋외이도절제＋시선절제급경부림파결청소술；1례Tis급4례T1외이도암환자행종류국부절제，5례T1환자행외이도연조직수상절제；6례T2환자행외이도연조직급골벽정괴절제＋유돌절제술，여종류침범외이도주위연조직칙가행시선천협절제；3례T3환자행섭골외측절제술＋시선절제＋시선구、경Ⅰ～Ⅴ구림파결청소；4례 T4환자행섭골차전절제＋시선절제＋하합관절절제술＋시선구、경Ⅰ～Ⅴ구림파결청소，창면이이전대체피판、이후대체피판、섭기판、유리조직판수복。결과소유환자술후균미출현상구연기유합혹피판배사정황。술후88．89％（32／36）적환자재불동정도상보류료환측은공능，단만기환자행방사치료후，은력손실가중。수방5년，13례이곽암실방3례，무복발병례，부1례인폐전이사망；23예외이도암실방5례，8례복발，3년생존솔77．78％（14／18）。결론이곽암조기역발현병철저절제，예후교호；외이도암기병은닉，조기역오진，수술치료월조，예후월호，술후은공능보존솔고。
Objective To investigate the clinical features ,surgical methods and prognosis of the external ear carcinoma(EEC) .Methods A retrospective analysis was performed on 36 patients with EEC ,who underwent sur‐gery in our department .Thirteen of the 36 patients had auricular carcinoma(AC) ,and the other 23 patients had ex‐ternal auditory canal carcinoma(EACC) .Surgical methods:For the patients with AC ,11 patients underwent topical resection ,and the other 2 patients underwent subtotal or total resection of auricle ,en block resection of the external auditory canal ,parotidectomy and ipsilateral neck dissection .For the patients with EACC ,5 patients (1 Tis and 4 T1) accepted topical resection;the other 5 patients in T1 stage underwent sleeve resection of the external auditory canal soft tissue .There were 6 patients in T2 stage underwent en bloc resection of the external auditory cannal ,plus mastoidectomy .Furthermore ,superficial parotidectomy was performed ,if the soft tissue was involved .There were 3 patients in T3 stage underwent lateral temporal bone resection , parotidectomy and ipsilateral neck dissection (paroid region ,Ⅰ - Ⅴ region) .As for the 4 patients in T4 stage ,they underwent subtotal temporal bone resec‐tion ,parotidectomy ,ipsilateral neck dissection ,and temporal-mandibular joint resection .In order to reconstruct the tissue defects ,we used the following flaps:preauricular pedicled skin flap ,postauricular pedicled skin flap , temporalis muscle flap ,and free tissue flap .Results All the patients healed well ,without necrosis of flaps .Thirty-two out of 36 (88 .89% ) patients had their auditory function preserved in different degrees .We failed to follow up 3 AC and 5 EACC patients .For the patients with AC ,there were no recurrence .Only 1 patient died of pulmonary metastasis in the fourth year after surgery .For the patients with EACC ,relapse occurred in 8 cases .The 3-year survival rate of all the patients with EACC was 77 .78% (14/18) .Conclusion Most AC can be removed complete‐ly ,and the prognosis is good .In the early stage ,EACC does not has typical clinical manifestation ,and it often be misdiagnosed .The primary treatment for EACC is surgery ,and the earlier the operation is performed ,the better prognosis is expected .