60例外耳道及中耳癌临床回顾性分析

发布时间：2018-03-07 20:00

  本文选题：癌症　切入点：外耳道　出处：《山东大学》2015年硕士论文　论文类型：学位论文

【摘要】：研究目的：探讨外耳道及中耳癌的临床表现、诊断方法、治疗策略和影响预后的危险因素,以期规范该病治疗措施,提高患者生存时间和生存质量。研究方法：回顾性分析我院2005年4月-2014年2月收治并经病理证实的60例外耳道及中耳癌患者的完整临床资料和随访信息。分析内容包括临床表现、病理类型、影像学表现、临床分期、治疗方案等。采用K-M法绘制各组患者的生存曲线,用COX比例风险模型分析不同危险因素与生存时间的相关性,选用的危险因素包括性别、年龄、T分期、手术切缘、淋巴结转移、面瘫、病理类型等。结果：根据Pittsburgh分期标准,T1期18例,T2期7例,T3期9例,T4期26例。其中,26例行颞骨外侧切除术,30例行颞骨次全切除术,2例于外院行扩大乳突根治术,1例行单纯化疗,1例行单纯放疗。全组患者5年总生存率、无复发生存率分别为67.3%、59.5%,早期(T1、T2期)病例5年生存率、无复发生存率均为100%,T3期病例5年生存率、无复发生存率分别为76.2%、62.2%,T4期病例的5年生存率、无复发生存率分别为32.9%、27.3%。手术加放疗组与单纯手术组病例的5年生存率分别为84.7%、51.3%,5年无复发生存率分别为70.0%、50.8%。在各危险因素中,T分期、手术切缘、有无面瘫、有无硬脑膜受累、病理类型对于预后有明显影响。结论：1、外耳道及中耳癌十分罕见,早期患者的预后情况良好,但是晚期患者的预后较差,因此早期诊断和治疗对于该病的预后至关重要。2、Pittsburgh分期标准是一种科学有效的分期手段,其分期和预后相关,对于指导手术方式的选择具有重要意义。3、我们推荐的最佳治疗方案为手术治疗联合术后放疗。早期患者推荐颞骨外侧切除术,晚期患者推荐颞骨次全切除术,部分可以采用颞骨外侧切除术,不推荐采用局部切除、乳突根治术、颞骨全切除术等。4、T分期为晚期、面神经受累、手术切缘阳性、硬脑膜受累、病理为鳞癌为预后不良的可能危险因素。硬脑膜受累和病理为鳞癌为生存率的独立危险因素,术后辅助放疗为保护因素。
[Abstract]:Objective: to investigate the clinical manifestations, diagnostic methods, treatment strategies and risk factors affecting prognosis of external auditory canal and middle ear cancer, in order to standardize the treatment of the disease. Methods: the complete clinical data and follow-up information of 60 patients with external auditory canal and middle ear cancer admitted from April 2005 to February 2014 in our hospital and confirmed by pathology were analyzed retrospectively. Including clinical manifestations, The survival curve of each group was drawn by K-M method, and the correlation between different risk factors and survival time was analyzed by COX proportional risk model. Age T stage, surgical margin, lymph node metastasis, facial paralysis, Results: according to the Pittsburgh staging criteria, 18 cases with stage T 1 and 7 cases with stage T 3 and 9 cases with stage T 4 were diagnosed as stage T 4. Among them, 26 cases were treated with lateral temporal bone resection and 30 cases with subtotal excision of temporal bone. 2 cases underwent radical mastoidectomy in other hospitals and 1 case underwent radical mastoidectomy. Chemotherapy alone was performed in 1 patient with radiotherapy alone. The overall 5-year survival rate of the patients was 5 years. The 5-year survival rate was 67.3% and 59.5%, respectively. The 5-year survival rate was 100% T _ 3 stage, and the recurrence free survival rate was 76.2%. The 5-year survival rate was 76.2% and 62.2% respectively. The 5-year survival rates were 84.7% and 51.3%, respectively, and the 5-year recurrence free survival rates were 70.0% and 50.8%, respectively. Among the risk factors, T stage, surgical margin, facial palsy and dura mater involvement were found in the operation plus radiotherapy group and the simple operation group, respectively. Conclusion: cancer of external auditory canal and middle ear is very rare. The prognosis of early patients is good, but the prognosis of late patients is poor. Therefore, early diagnosis and treatment are very important to the prognosis of the disease. 2 Pittsburgh staging is a scientific and effective staging method, and its staging is related to prognosis. It is of great significance to guide the choice of surgical methods. 3. The best treatment we recommend is surgery combined with postoperative radiotherapy. Lateral temporal bone resection is recommended for early patients and subtotal temporal bone resection is recommended for late patients. Partial lateral temporal bone resection is not recommended. Radical mastoidectomy and total excision of temporal bone are not recommended for the late stage. The facial nerve is involved, the surgical margin is positive, and the dura mater is involved. Pathology was a possible risk factor for poor prognosis, dura mater involvement and pathology were independent risk factors for survival of squamous cell carcinoma, and postoperative adjuvant radiotherapy was a protective factor.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R739.61

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