复发性涎腺多形性腺瘤的临床与病理分析

Clinicopathologic study on recurrent pleomorphic adenoma of salivary gland

目的 探讨复发性涎腺多形性腺瘤（recurrent pleomorphic adenoma，RPA）的临床与病理特点。方法1962～2002年间在我院因涎腺RPA住院手术治疗的患者121例，对其中随诊10年以上的38例患者进行临床与病理分析。结果腮腺、颌下腺及腭腺最多，复发次数分别为6、12、4次。单发14例，多发24例。腮腺及腭腺复发肿瘤除原手术野、手术切口瘢痕处外，6例多次复发后向腮腺深叶、咽旁及颅底扩展。34例中，病理类型以粘液成分为主型4例，细胞密集型13例，混合型17例。结论结合病理研究，肿瘤复发的主要原因是残留瘤芽及术中肿瘤包膜破裂种植。复发肿瘤位置表浅、单发者可手术局部摘除。多发、位置深在者需行解剖面神经的肿瘤摘除术。避免涎腺多形性腺瘤术后复发的关键是第一次手术的术式，防止肿瘤包膜破裂并严格遵守无瘤手术原则。

Objective To study the cllnicopatholglc characteristics of recurrent pleomorphic adenoma （RPA） of salivary gland. Methods During the period between 1962 to 2002, thirty eight eases of RPA of salivary gland surgically treated in our hospital were followed up for more than ten years and were studied clinically and histopathologleally. Results The maximal frequency of recurrences in parofid gland, submandlbular gland and palate were 6,12,4 times respectively. The recurrent tumors presented as single nodule in 14 cases, multinodules in 24 eases. RPAs were not only occurred at the original locations ,but also extended into the deep parotid lobe, parapharyngeal space and the base of skull after multiple recurrences. Among 34 cases with histological subclassification, 4 cases were subclassified as myxoid pattem, 13 cases were as dense cellular pattem and 17 eases were as mixed pattem. Conclusion Based on the results of pathological study, the causes of recurrence of the tumor are considered due to residue of tumor and seeding of tumor cells during the surgery. Solitary small nodule can be treated adequately by local excision, especially when the tumors are close to the skin, multiple recurrent nodules or the deep - located tumor require radical trumor resection with preservation of facial nerve. The crucial importance to avoid local recurrence of pleomorplie adenma is to use standard treatment of the lesions during the first surgery, tumor - free manipulation is the one of surgical principles which surgeons should obey.