腮腺低度恶性肿瘤的个性化治疗

摘要

Objective Parotidectomy and superficial parotidectomy are traditional surgical treatment to the malignant parotid gland tumour although they have many defects.The aim of this study was to analyze the feasibility of individualized treatment to patient according to tumor`s size and TNM stage. Methods Thirty three patients with low grade malignant parotid gland tumours from Dec 2005 to Dec 2010 were recruited in the present study.All the patients received the territorial surgical resection firstly.Then, 9 cases re-ceived the expanded territorial surgical resection (1 case had recurrent probability, accepted adjuvant radiotherapy).Sixteen cases un-derwent parotidectomy with complete tumor resection ( 2 case had envelope invasion, accepted adjuvant radiotherapy) .Eight cases ac-cepted adjuvant radiotherapy(4 cases on T1 and T2 stage preserved facial nerve although the nerves adhering to tumors, and other 4 ca-ses on T4a stage accepted facial nerve excision ) . Results Follow up ranged from 3.5 to 8.5 years and no recurrences were docu-mented.9 patients who accepted territorial surgical resection showed fine facial symmetry.8 cases of them without adjuvant radiotherapy had good salivary secretion.Nine cases of other 24 patients showed temporary facial nerve injury and recovered within 1 to 4 months. Four cases with facial nerve excision showed permanental facial paralysis. Conclusion To protect the function of parotid gland to the greatest extent, the small low grade malignant parotid gland tumors without facial nerve invasion could have territorial surgical resection. Combined territorial surgical resection with postoperative adjuvant radiation therapy is useful to avoid the tumors recurrence and en-croachment of facial nerve to protect the facial nerve function.%目的：腮腺全切、肿瘤＋浅叶腺体切除是治疗腮腺恶性肿瘤采用的常规术式，但存在较多缺陷。文中依据患者肿瘤大小、分期等采用不同治疗方案，分析个性化治疗方案的可行性。方法选取2005年12月至2010年12月收治的33例腮腺低度恶性肿瘤患者，所有患者均先行肿瘤＋周围腺体局部切除术后，9例患者行区域性扩大切除术（其中1例术后病理提示有肿瘤复发倾向，辅助放疗），16例行肿瘤＋腮腺全切除术（其中2例术后病理提示肿瘤侵犯包膜，辅助放疗），8例（ T1、T2期4例患者保留面神经，T4a期4例患者行面神经切除）行辅助放疗。结果所有患者随访3．5～8．5年，均无复发。行区域性扩大切除术的9例患者面神经保存完好，其中未行放疗的8例患者唾液分泌功能良好；其余24例患者中有9例患者术后出现暂时性面神经损伤症状，1～4个月后均完全恢复；行面神经切除的4例患者遗留面神经瘫痪症状。结论对无面神经受侵、肿瘤体积较小的高分化黏液表皮样癌、腺泡细胞癌、上皮-肌上皮癌等腮腺低度恶性肿瘤患者行区域性扩大切除术能最大程度保存腮腺功能；而对面神经与肿瘤粘连、受侵犯的患者可行肿瘤＋周围腺体局部切除＋术后放疗可保留面神经的功能、防止肿瘤复发、转移。