颈静脉球瘤诊断与治疗(附8例报告)

目的 探讨颈静脉球瘤的临床特点、诊断要点及巨大颈静脉球瘤的手术治疗方法。方法 回顾性分析2000至2009年深圳市第二人民医院及山东大学齐鲁医院耳鼻咽喉科收治的8例颈静脉球瘤的病例资料。结果 8例患者中,男5例,女3例； 33～62岁；均为单耳病变，左耳2例,右耳6例；主要临床症状为搏动性耳鸣、声音嘶哑、听力下降和面瘫。临床表现结合CT、MRI等影像学检查可明确诊断。所有病例均经术后病理证实。按1979年Fisch分型,A型0耳,B型1耳,C型1耳,D1型4耳,D2型2耳。均给予手术治疗，2例行单纯乳突根治术，6例行颞颈联合入路彻底切除肿瘤。术中2例出现脑脊液漏均经硬脑膜修补后治愈；2例术后面瘫,1例经治疗后缓解，1例为永久性；原有声音嘶哑、搏动性耳鸣缓慢消失。随访6例，单纯乳突根治术2例中，1例随访5年未复发，1例失访；余5例中，有1例术后第2年复发，给予放射治疗； 2例随访7年，1例3年，1例2年，均未复发。结论 颈静脉球瘤易误诊；诊断主要根据病史、临床及影像学检查，其中影像学对确诊起重要作用。手术切除是目前治疗颈静脉球瘤最好的方式，入路的选择对于手术的成功起决定性作用。

Diagnosis and treatment of glomus jugulare tumor: a report of 8 cases

Objective To investigate the clinical feature, diagnosis and management of glomus jugulare tumors and operative methods for complex tumors. Method The data of eight cases of glomus jugulare tumors were retrospectively analyzed. Results Among 8 patients, 5 were females and 3 males with average age of 41 years(33-62 years). The tumors were located in the left ear in 2 cases and the right in 6 cases. Pulsatile tinnitus, hoarse voice, hearing loss and prosopoplegia wer the main symptoms. Final diagnosis depended on clinical manifestation, CT and/or MRI. According to the Fisch classification, the tumor in 1 ear was type B, 1 was type C, 2 were type D1 and 2 were type D2. All the tumors were completely removed; two had recurrence after 3 years; 4 patients with residual tumor had no changes after taking radiotherapy of 3 years. Conclusion Surgical approaches allow complete resection of the tumor. And pre-operative embolization is able to reduce the operation time and blood loss.