鼻及鼻窦多形性腺瘤15例报告

Pleomorphic adenoma of nose and accessory nasal sinuses:a report of 15 cases

目的 :探讨鼻及鼻窦多形性腺瘤的临床特点和治疗方法。方法 :15例鼻及鼻窦多形性腺瘤患者 ,行上颌窦根治术 2例 ,用圈套器作鼻息肉切除术 2例 ,鼻侧切开术 10例 ,上颌骨切除术 1例。结果 :首次术后无复发 7例 ,复发 6例 ,种植性复发 1例 ,恶变 (癌肉瘤 ) 1例。 6例复发者再次手术后无复发 2例 ,复发 2例 ,恶变 2例 ;1例种植性复发者行放疗 6 0Gy无效死亡。 结论 :鼻及鼻窦多形性腺瘤误诊率高 ,复发率高 ,多次手术易恶变 ;治疗的关键在于首次手术采用大术野彻底清除病灶 ,如怀疑是该肿瘤则术中应作快速切片 ,术前尽量不做活检以防瘤体破裂 ;预后与肿瘤复发和恶变有关。

Objective: To discuss the clinical characteristics and the treatment of pleomorphic adenoma of nose and accessory nasal sinuses(NPA). Method: Fifteen cases of NPA were treated,2 cases underwent radical maxillary sinusotomy,2 cases nasal polypectomy,10 cases lateral rhinotomy and 1 case maxillectomy. Result: No recurrence occurred in 7 cases,recurrence occurred in 6 cases,planted recurrence occurred in 1 case,malignant evolution occurred in 1 cases(carcinosarcoma) after the first operation. The 6 cases of recurrence underwent an operation for the second time,2 cases had no recurrence,2 cases recurred again,2 cases became malignant (one was adenoid cystic carcinoma,the other was squamous cell carcinoma).The case who was planted recurrence underwent radiotherapy with 60 Gy and died of failure to respond to medical treatment at last. Conclusion: The rate of recurrence and misdiagnosis is very high in NPA,this tumor can be malignant evolution easily after many operations.To get rid of focus completely,it is important to apply a wide range of surgical operation in the first operation,which is the key to treatment.Rapid sections-cutting for microscopic examination should be done during operation, biopsy must not be done before operation if a tumour of nose is suspected to be NPA. Prognosis of this tumour is mainly linked to recurrences in cases of incomplete resection and to possible metastasis,such as an eventual malignant evolution.