涎腺腺样囊性癌40例临床病例分析

Clinical analysis of salivary adenoid cystic carcinoma in 40 patients

[目的]通过分析40例涎腺腺样囊性癌（salivary adenoid cystic carcinoma,SACC）临床病例,了解其发病情况,探讨影响SACC的预后因素。[方法]选择1986年8月～2002年6月在大连医科大学附属第一医院口腔颌面外科诊治的涎腺恶性肿瘤手术患者108例,均经病理科确诊,其中腺样囊性癌40例。肿瘤分期按UICC（2002年）TNM分类进行;肿瘤病理参考WHO（1991年）的涎腺肿瘤组织学新分类法。[结果]SACC占涎腺恶性肿瘤的37.04%,腮腺和颌下腺多发,平均患病年龄51.83岁,男女比为1∶1;腺样囊性癌的死亡原因主要是局部复发和远处转移,发生在颌下腺和腭部及其他小涎腺的SACC复发率和转移率高,Ⅲ和Ⅳ期相对于Ⅰ和Ⅱ期的复发率高,实性型比腺样-管状型SACC的复发率和转移率高,神经受侵者比非神经受侵者SACC的复发率和转移率高。[结论]SACC是最常见的涎腺恶性肿瘤;SACC术后复发率和转移率较高,这与肿瘤的发病部位、临床分期、病理分型及有无神经侵袭情况具有相关性。

[Objective] This was to analyze the clinical manifestation of salivary adenoid cystic carcinoma（SACC） in 40 patients,and studied the important factors related to the prognosis comprehensively.[Methods] Pathologically diagnosed 108 patients with salivary gland malignant neoplasm were collected with 40 cases of SACC among them.The clinical stage was carried out by the TNM classification of UICC in 2002,and by the pathologic type according to the new method of WHO in 1991（salivary gland tumor）.[Results] Adenoid cystic carcinoma was most common in salivary gland malignant tumors that accounted for 37.04%.Parotid gland and submandibular gland were the most commonly original sites.The age of patients was 51.83 in average with the ratio of male to female being 1∶1.The main cause of death in SACC was local recurrence and distant metastasis.The rates of recurrence and metastasis were higher in submandibular gland and minor salivary gland in palate,Ⅲ and Ⅳ stage,solid type and nerve invaded than other sites,Ⅰ and Ⅱstage,sieve-tubular and non-nerve invaded.[Conclusion] Salivary adenoid cystic carcinoma is the most common salivary gland malignant tumor with high morbidity.The recurrence and metastasis rates in SACC are high after treatment,which depend upon sites of tumor,clinical stage,histological type and nerve involvement.