中耳恶性肿瘤33例临床分析

Management of middle ear malignancies

目的探讨中耳恶性肿瘤的临床特点和治疗策略。方法回顾性分析解放军总医院1997—2007年经治的33例中耳恶性肿瘤患者,其病理类型分别是25例鳞状细胞癌,5例腺癌,2例粘液表皮样癌及1例横纹肌肉瘤。结果按照Stell分期为Ⅰ期2例,Ⅱ期12例,Ⅲ期19例。8例行扩大的乳突根治术,19例行颞骨次全切除术,6例接受颞骨全切除术。以阔筋膜修复缺损的硬脑膜,以胸大肌皮瓣、胸锁乳突肌瓣、颞肌瓣等单独或联合修复术腔缺损。1例患者单独接受手术治疗,32例患者接受手术+放疗的综合治疗。全组总的3年、5年生存率分别是85.2%、74.7%。有血性耳漏患者与无血性耳漏患者的3年生存率分别是74.1%和89.1%(P=0.049)。结论对中耳恶性肿瘤的患者采取扩大切除加术后根治性放疗可提高生存率,持续的血性耳漏可能是预后不良的表现。

[Abstract ] Objective To study clinical presentation , treatment and outcomes of middle ear malignant tumors. Methods Thirty three cases of malignant tumors of the middle ear treated from 1997 to 2007 were reviewed retrospec- tively for their clinical characteristics and treatment modalities （surgery with or without postoperative radiotherapy）. The pathological entities included squamous cell carcinoma （n=25）, adenoearcinoma （n=5）, mucoepidermoid carcinoma （n = 2） and rhabdomyosarcoma（n = 1）. Results The cases were in stage Ⅰ （n=2）, Ⅱ （n= 12） and Ⅲ （n= 19） on Sell staging. Surgical approaches included extended mastoidotympanectomy （n = 8）, subtotal temporal bone resection（n = 19） and total temporal bone resection （n = 6）. Except for 1 patient who received only surgical treatment, all other 32 patients were treated with both surgery and radiation therapy. The 3- and 5-year accumulative survival rates were 85.2% and 74.7%, respectively. The 3- year survival rate was lower in patients presenting with bloody otorrhea （74.1%） than in those with- out （89.1%） （P= 0.049）. Surgical complications occurred in 4 patients with 1 death. Conclusion In patients with malignant tumors of the middle ear, extended excision is an effective management when combined with postoperative radiation therapy. Presentation with blood otorrhea may indicate poor prognosis.