颞骨恶性肿瘤临床诊疗的现状

Current Opinions on Clinical Diagnosis and Treatment of Temporal Bone Malignancy

颞骨恶性肿瘤发病率低,临床症状不典型,经常被误诊为具有相似症状的良性疾病延误病情。颞骨高分辨CT及增强MRI能明确肿瘤病变范围和性质,同时结合病理结果对肿瘤的诊断更为精确。通过明确不同疾病性质、分期及累及部位选择适合的手术及其他治疗方式,最大程度上切除肿瘤获得手术安全切缘,减少复发,提高生存率。颞骨恶性肿瘤患者就诊时常处于晚期,常侵犯周围的重要组织器官,进一步增加手术的难度。手术以整块切除并尽可能取得安全切缘为原则。晚期恶性肿瘤侵袭范围广,手术难以完全切除,因此建议综合治疗,术前或术后给予放化疗。

Due to the low incidence and nonspecific symptoms of temporal bone malignancies, patients with temporal bone carcinoma are often misdiagnosed with benign disorders. High resolution temporal bone CT scan and enhanced MRI can define the extent and nature of the lesion, which makes diagnosis more accurate when combined with histological examination. Such information will benefit the surgeon in choosing optimal management strategies, obtaining an as far negative surgical margins as possible to reduce recurrence and improve prognosis. However, advanced tumors always invade surrounding vital neurovascular structures, which increases the difficulty of surgery. Concerning the extensive tumor invasion and difficulty in en bloc removal in such situations, it is suggested that these patients should be treated with the combination of surgery and pre-/postoperative chemoradiotherapy.