26例中耳鳞状细胞癌的诊断与治疗

The diagnosis and treatment of 26 cases of middle ear squamous cell carcinoma

目的对26例中耳恶性肿瘤的临床表现、早期诊断标准进行分析。方法总结26例中耳恶性肿瘤患者的临床特征,其中男性22例,女性4例,年龄26-71岁,平均54.6岁,治疗方法以中耳乳突根治术为基础,根据病变范围决定手术方式,其中3例行乳突扩大根治术,17例颞骨次全切,6例颞骨全切除术,并同时对有颈淋巴结转移的病例行颈淋巴结廓清术,术后配合放射治疗。结果本组病例均经病理组织学证实为中耳鳞状细胞癌,随访时间均满5年以上,Ⅰ期术后随访无复发,全组Ⅱ-Ⅲ期复发率为34%,5年生存率88%。结论对中耳恶性肿瘤患者严格掌握手术适应症。早期诊断和正确的治疗是提高5年生存率的关键。

Objective To explore the clinical manifestation and early diagnosis of 26 cases of middle ear squamous cell carcinoma. Methods This essay summarized retrospectively the clinical experience of 26 patients suffering from middle ear carcinoma. These carcinoma occurred in patients between 26 and 71 years old of age （average 54.6 years old） and there was a preference for male （22/26 cases）. According to regions involved by carcinoma of the middle ear, the operative approaches were selected. The surgical procedures included extended mastoidotympanectomy in 3 cases, subtotal temporal bone resection in 17 cases, and temporal bone resection in 6 cases. The patients with cervical metastases were treated by radical neck dissection and postoperative radiotherapy. Results The 26 patients had been followed up over five ,years. Follow-up survey showed that no one recrudesced in stage Ⅰ and the recurrence rate was 34% in stage Ⅱand stage Ⅲ patients. The 5 years survival rate was 88% in the whole group. Conclusions According to regions involved by carcinoma of the middle ear, the operative approaches and radiotherapy were selected. An early diagnosis and the right choice of treatment is the key to increase the 5 years survival rates.