外耳道腺样囊性癌24例临床分析

目的探讨外耳道腺样囊性癌的临床诊断和治疗策略。方法回顾性分析解放军总医院1996—2007年经治的24例外耳道腺样囊性癌患者的临床资料，并用Kaplan-Meier法计算生存率。结果全组24例患者中，行局限性外耳道肿物切除术3例，行部分骨性外耳道和软骨切除加乳突根治术11例，行颞骨次全切除术9例，颞骨全切除术1例。4例晚期患者腮腺因受侵而切除。23例患者术后加用辅助放疗。全组总的5年累计生存率为71-4％．10年累计生存率为38．1％；临床误诊的患者与未被误诊患者的10年生存率分别为21．9％和59-3％（P=0．012）。结论外耳道腺样囊性癌生长缓慢，但长期效果差，对肿瘤的扩大切除可能提高生存率、降低复发，手术加放疗是有效的综合治疗策略。

A review of 24 cases of external auditory canal adenoid cystic carcinoma

Objective To evaluate management of adenoid cystic carcinoma in the external auditory canal. Methods Twenty four cases of adenoid cystic carcinoma of the external auditory canal treated at the Chinese PLA General Hospital from 1996 to 2007 were reviewed retrospectively. The survival rates were calculated using the Kaplan-Meier method. Results Treatments in the 24 cases included local mass resection(n= 3), extended mass resection including part of the external auditory canal and mastoidectomy (n= 11), subtotal temporal bone resection (n= 9) and total temporal bone resection (n=1). Parotidectomy was performed in 4 cases with advanced lesions involving the parotid. Adjuvant radiotherapy was performed in 23 cases. The 5- and 10-year accumulative survival rates were 71.4% and 38.1%, respectively. The 10- year survival rate was 21.9% for patients who had been misdiagnosed and 59.3% for those who were correctly diagnosed at first presentation (P = 0.012). Conclusion Adenoid cystic carcinoma in the external auditory canal is a slow growing disease but with a poor long-term prognosis. Early diagnosis and complete removal of disease may improve survival and decrease recurrence. Adjuvant radiotherapy is useful.