43例涎腺粘液表皮样癌的临床分析

目的：探讨涎腺粘液表皮样癌（MEC）的组织学分型和临床分期与手术预后的关系，为临床确定理想的治疗方案提供参考和依据。方法：对43例得到病理学证实的涎腺MEC的发病部位、临床表现及基组织学分型、TNM分类和临床分期与手术治疗预后的相关性进行分析。结果：在得到长期随访的36例中，6例出现局部复发或区域淋巴结转移，其中在组织学上属高分化型4例，低分化型2例；属临床Ⅰ、Ⅱ期1例，Ⅲ、Ⅳ期5例；现生存23例，死亡13例，其中死于MEC4例，死于其他疾病9例；死于MEC的4例均属临床Ⅲ、Ⅳ期。这表明MEC术后的复发转移率和病死率与其组织学分型无明显相关（P＞0．05），而与临床分期关系密切（P＜0．01），临床Ⅰ、Ⅱ期MEC的手术预后明显优于Ⅲ、Ⅳ期。结论：对于临床Ⅲ、Ⅳ期的MEC应高度重视原发灶手术切除的彻底性及相应区域的淋巴结清扫。对手术切除不彻底的病例，可考虑术后放疗。

A clinical analysis of 43 patients with mucoepidermoid carcinoma of the salivary gland

Objectives: To study the histopathological grading and the clinical-staging system on the surgical prognosis in patients with mucoepidermoid carcinoma(MEC) of the salivary glands. 　Methods: Analysis were made to the primary sites, clinical findings and the correlation between the histopathological-grading/clinical-staging system and the surgical prognosis in 43 patients with pathological evidence of MEC. 　Results: Recurrence or regional lymph node metastasis were diagnosed in 6 of the 36 MEC patients, among which 4 were well differentiated and 2 were poorly differentiated, 1 was in stage Ⅰ to Ⅱ, and 5 were in the stage of Ⅲ or Ⅳ, there were 23 survivors. Thirteen of the 36 patients died, 4 of whom from MEC and 9 from reasons not related to MEC. All the died were in stage Ⅲ or Ⅳ. 　Conclusions: Recurrence or metastasis of MEC correlates with clinical-staging, but not related to the histopathological grading, this suggested that ablative surgery of the primary tumor and dissection of the regional lymphatic system are required in cases of Ⅲ and Ⅳstage MEC. Postoperative irradiation is proposed in the event of inadequate resection.