手术后放疗治疗外耳道中耳癌的临床观察

Treatment results and influenced factors of 41 cases of carcinoma in the external auditory canal and middle ear

目的 :观察手术后放疗对 4 1例外耳道中耳癌的疗效及其影响因素。方法 :对 4 1例外耳道中耳癌患者根据Stell分期法 ,T1 期 2例行局部切除 ,T2 期 1 8例行乳突根治术 ,T3 期 2 1例行颞骨部分或全部切除术 ;术后均加放疗 ,进行疗效比较。结果 :治疗后随访 5～ 1 3年 ,5年生存率在T1 、T2 和T3 分别为 1 0 0 .0 %、5 5 .6 %和9.5 % ;总的 5年生存率为 34.1 % ;T1 与T3 比较 ,差异有显著性意义 (P <0 .0 5 ) ;T2 与T3 比较、T1 + 2 与T3 比较 ,差异均有极显著性意义 (P <0 .0 1 )。伴或不伴疼痛的 5年生存率为 2 2 .2 %及 5 7.1 % ,其差异有极显著性意义(P <0 .0 1 ) ;伴或不伴面瘫者的 5年生存率分别为 1 0 .5 %及 5 4 .5 % ,其差异也具有极显著性意义 (P <0 .0 1 )。结论 :外耳道中耳癌的疗效与分期、是否伴有疼痛和面瘫有关 ,因此早期诊断。

Objective:To analyze the results and influenced factors of the management of carcinoma in the external auditory canal and middle ear (41 cases) treated in our department from 1973～1995.Method:According to Stell's stage system, there were 2 patients with T 1 stage, 18 cases with T 2 stage and 21 with T 3 stage. All patients were treated by surgery then followed by radiation. The surgery procedure was different according to the T stages. A simple incision was used to the T 1 cases. Radical mastoidectomy was performed on the T 2 patients. And the T 3 cases had a partial or total petrosectomy. Statistics was done to compare the differences of 5-year survival rates between T stages and that between the cases with and without pain or facial nerve paralysis.Result:All patients were followed up for 5～13 years. The 5 year survival rate in T 1,T 2 and T 3 was 100%, 55.6 % and 9.5 %, respectively. The total survival rate was 34%. The difference between T 1 and T 3 was significant(P< 0.05 ); differences between T 2 and T 3 as well as T 1+2 and T 3 were also significant (P< 0.01 ). The 5 year survival rates in patients with and without presenting symptom of pain were 22% and 57% , the difference was significant (P< 0.01 ). The 5 year survival rates in patients with and without facial nerve paralysis were 10% and 55%, the difference was also significant (P< 0.01 ).Conclusion:The result of management of carcinoma in the external auditory canal is associated with the tumor stages and the accompanying symptoms such as pain and facial nerve paralysis. Therefore, early diagnosis and management is important.