外耳道、中耳恶性肿瘤治疗方案的探讨

目的探讨外耳道、中耳恶性肿瘤的治疗方案及相关问题。方法回顾性分析1990—2005年我科收治的34例外耳道、中耳恶性肿瘤的临床资料,其中6例为复发病例,面神经受累7例。34例中4例行单纯放射治疗;30例根据肿瘤的不同部位和侵犯范围行不同的手术治疗,其中26例行术后放射治疗,放疗剂量为50～60GY。结果本组34例。术前面神经未受侵犯的27例中,术后6例发生不同程度的面瘫,其中5例术后3个月逐渐恢复,1例不全恢复。4例行单纯放射治疗者,1例早期病例存活61个月,其余3例分别在治疗后12、23以及31个月复发死亡。4例行单纯手术治疗者,2例早期病例分别存活62、72个月;另2例拒绝术后放疗,分别存活24、61个月。行手术加术后放疗的26例中,3年生存率为53.2%,5年生存率为43.5%,复发多在2～5年内。结论外耳道、中耳恶性肿瘤针对不同的病例选择合适的治疗方案,对提高疗效、保留功能和外观等有重要意义。

Evaluating the treatment of carcinomas of the external auditory canal and middle ear

0bjective To evaluate the treatment of carcinoma of the external auditory canal and middle ear. Methods Thirty-four cases of carcinomas of the external auditory canal and middle ear treated at our department from 1990 to 2005 were analysised retrospectively, of whom 6 cases were recurrent, the facial nerve were invasioned in 7 cases. Four cases were treated with radiation therapy alone, while 30 cases were treated with individualized operation according to the location and involved regions, of whom 26 cases received postoperative radiation therapy with the dosage form 50 Gy to 60 Gy. Results Among the 27 cases whose facial nerves were not be invasioned before operation, 6 cases had facial paralysis after operation. Of them, 5 cases had recovered gradually in three months and 1 patient had recovered partially. One case of early stage out of the 4 cases who treated with radiation therapy alone had survived for 61 months, the others had survived for 12, 23 and 31 months respectively and died of recurrence. While among the 4 cases treated with operation alone, 2 cases of early stage without radiation therapy had survived for 62 and 72 months, the other 2 cases who were not reluctant to accept the postoperative radiation therapy, had survived for 24 and 61 months, respectively. Among the 26 cases who received the combined therapy, the 3-year survival was 53.2%, the 5-year survival was 43.5%, and the recurrence occured mostly in following 2 to 5 years. Conclusion Applying the rational treatment according to the various conditions of the patients who had carcinoma of the external auditory canal and middle ear is very important to increase the therapeutic effect and retain the function and appearance.