侵及颈静脉孔的颞骨恶性肿瘤临床特征研究

发布时间：2018-05-19 06:55

本文选题：颞骨恶性肿瘤 + 颈静脉孔　；参考：《复旦大学》2013年硕士论文

【摘要】：目的：了解侵及颈静脉孔颞骨恶性肿瘤的临床表现,影像学特征,手术方式及预后,探讨术前评估,围手术期处理、手术方式对全切病变及预防并发症的意义。资料和方法：回顾性分析复旦大学附属眼耳鼻喉科医院2006年10月至2012年10月手术治疗的10例侵及颈静脉孔颞骨恶性肿瘤,病理类型包括6例鳞状细胞癌,2例腺样囊性癌,1例耵聍腺癌,1例软骨肉瘤,术前检查包括听力检查、面神经电图(ENoG)、硬管喉镜、高分辨率颞骨CT(HRCT)、增强头颈部核磁共振(MRI)。对于肿瘤血供丰富的病例,行数字减影血管造影(DSA)了解血供情况,甚至行血管栓塞。统计分析临床症状、体格检查、听力及影像学检查、手术方式及随访资料。最常见的症状是传导性聋、其次是耳流脓、耳痛。最常见的侵及部位是外耳道、中耳、面神经。3例患者术前在外院被误诊。5例患者采用改良的颞下窝入路,5例患者采用乳突颈部联合入路手术。结果：随访时间2-79月,平均26.3月,随访期间,4例死亡,生存率为60%。1例患者出现术后面瘫(H-B IV),未做面神经移植,1例患者行血管栓塞后出现声嘶、吞咽困难、伸舌偏向和抬臂困难,另有1例患者放疗后出现抬臂困难加重,1例患者术后脑脊液漏修,保守治疗后恢复。结论：侵及颈静脉孔的颞骨恶性肿瘤,发病率低,临床表现复杂且无特异性,容易漏诊或误诊；颈静脉孔解剖复杂,手术难度大,应该根据肿瘤的位置、大小、侵及范围、听力水平、后组颅神经功能以及术者的经验,选择个性化的手术方式,术中尽量保存后组颅神经和面神经的功能；侵及颈静脉孔的颞骨恶性肿瘤预后差,特别是鳞癌,复发肿瘤预后更差,首次治疗应尽可能完全切除病变,防止复发,应辅助放疗或化疗。
[Abstract]:Objective: to investigate the clinical manifestations, imaging features, surgical methods and prognosis of the tumors involving the foramen and temporal bone of the jugular vein, and to explore the significance of preoperative evaluation, perioperative management and operative methods in the total resection of lesions and the prevention of complications. Materials and methods: ten cases of temporal bone malignant tumors involving jugular foramen were analyzed retrospectively, which were operated from Oct 2006 to Oct 2012, affiliated to the Department of Ophthalmology, Otolaryngology, Fudan University. The pathological types included 6 cases of squamous cell carcinoma, 2 cases of adenoid cystic carcinoma, 1 case of carcinoma of cerumen and 1 case of chondrosarcoma. Preoperative examination included hearing examination, facial electroencephalogram (ENoG), hard tube laryngoscope, high resolution temporal bone CTT HRCTT, enhanced head and neck MRI. For cases with abundant blood supply, DSAs were performed to understand the blood supply and even embolism. Statistical analysis of clinical symptoms, physical examination, hearing and imaging examination, operation and follow-up data. The most common symptom is conductive deafness, followed by purulent ear, ear pain. The most common site of invasion was external auditory canal, middle ear and facial nerve. 5 cases were misdiagnosed in external hospital before operation. 5 cases were treated with modified infratemporal fossa approach. 5 cases were treated by combined mastoid and cervical approach. Results: the follow-up period was 2-79 months (mean 26.3 months). During the follow-up period, 4 patients died, the survival rate was 60.1 cases with postoperative facial paralysis and H-B IVP, and 1 case without facial nerve transplantation showed hoarseness, dysphagia, tongue deviation and arm lifting difficulty after vascular embolization. Another patient had severe arm lifting difficulty after radiotherapy and 1 patient had cerebrospinal fluid leakage after radiotherapy and recovered after conservative treatment. Conclusion: the incidence of temporal bone malignant tumor invading jugular foramen is low, the clinical manifestation is complex and nonspecific, it is easy to miss diagnosis or misdiagnosis, the anatomy of jugular foramen is complicated and the operation is difficult, so it should be based on the location and size of the tumor. Hearing level, cranial nerve function in the posterior group, experience of the operator, choice of individualized operation method, preservation of the cranial and facial nerve function of the posterior group during operation, poor prognosis of malignant tumors of temporal bone involving jugular foramen, especially squamous cell carcinoma, The prognosis of recurrent tumors is worse, the first treatment should be as complete as possible to remove the lesions, prevent recurrence, should be adjuvant radiotherapy or chemotherapy.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R739.6

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