颞骨切除后的重建

颞骨切除后软组织缺损的重建可从简单的外耳道缝合到复杂皮瓣整复大面积组织缺损。该文报道１９８７～１９９６年中３４例因肿瘤侵犯颞骨而行侧颅底切除及其重建术的经验。手术操作分为：袖套式切除术、颞骨侧切除术、颞骨次全切除术,未行全颞骨切除术。结果：７例病人行袖套式切除术／或乳突根治术,袖套式切除术后可采用鼓室成形术、外耳道重建术或外耳道封闭术进行修复;２４例病人行颞骨侧切除术,４例行颞骨次全切除术,由颞骨侧切除或颞骨次全切除术所产生的大面积缺损需要通过颞肌瓣和局部旋转皮瓣联合修复（１３例）,低位岛状斜方…     

骨性外耳道后壁重建鼓室成形术治疗胆脂瘤型中耳炎的疗效观察

目的：探讨处理乳突根治术后遗留的外耳道后壁缺损及开放的乳突腔的方法。方法：应用骨性外耳道后壁重建鼓室成形术治疗胆脂瘤型中耳炎58例（58耳），清除病变的同时以颞骨皮质骨行骨性外耳道后壁重建并Ⅰ期行鼓室成形术。结果：随访1～3年，仅有1例胆脂瘤复发（复发率1．72％）。外耳道接近正常形态，保留含气乳突腔。纯音听阈提高30dBHL以上者（极效）5耳，提高20～29dBHL者（显效）11耳，提高10～19dBHL者（有效）30耳，总有效率为79．31％（46／58），〈10dBHL者（基本无效）8耳，无听力提高者（无效）4耳。术后平均气导听阈明显减少。结论：乳突根治术后以颞骨皮质骨行骨性外耳道后壁重建并Ⅰ期行鼓室成形术，有助于修复乳突根治术后遗留的外耳道后壁缺损及开放的乳突腔，改善听力，降低胆脂瘤复发率，是一种较为实用的手术方法。     

外耳道腺样囊性癌8例临床分析

目的 探讨外耳道腺样囊性癌的临床病理特点，总结疗效。方法 回顾性分析1985-2001年收治的8例外耳道腺样囊性癌患者的临床资料。结果 8例患者中行局部肿瘤切除2例；行外耳道袖状切除加腮腺浅叶切除2例；行肿瘤切除加扩大乳突根治3例（1例手术5次，最后1次行颞骨次全切除术）；行耳廓全切除加颞骨次全切除术1例。后4例术后辅以放疗。随访5～15年，2例健在，2例6年后肺转移带瘤生存，2例8年后死于肺转移，2例失访。结论 外耳道腺样囊性癌早期确诊和彻底手术是延长患者生命的关键。肿瘤易发生肺转移，远期预后不佳，提倡综合治疗。     

外耳道胆脂瘤19例临床分析

目的：探讨外耳道胆脂瘤(EACC)的临床特征,提高其临床诊治水平。方法：回顾分析19例手术治疗后经病理检查证实为EACC患者的临床资料。对9例骨质破坏局限于外耳道且范围小者,行外耳道病灶清除术加外耳道耳甲腔成形术;对10例胆脂瘤侵入上鼓室或乳突累及中耳者,采用耳后或耳内进路,行乳突根治术5例,改良乳突根治术5例,病变清除后,均行外耳道成形术。结果：术后听力较术前提高10～20dB9例,无变化10例。随访1～12年,无复发。结论：详细的病史询问和仔细的耳镜检查及颞骨CT扫描,在EACC的诊断中有着十分重要的价值。治疗原则是彻底清除胆脂瘤和死骨,防止胆脂瘤残留和复发,并根据病变程度决定手术方式。     

完整骨性外耳道鼓室成形术治疗胆脂瘤型中耳炎疗效观察

目的 探讨完整骨性外耳道鼓室成形术对骨性外耳道缺损重建及对听力、干耳、术后大术腔引起耳部不适症状的影响。方法 2006～2010年收治胆脂瘤型中耳炎72例,按手术方式分为两组：对照组为开放式,采用乳突根治术或改良乳突根治术;观察组为完整骨性外耳道鼓室成形术,术中在彻底切除病变组织的同时保留或重建骨性外耳道。结果 与传统乳突根治术或改良乳突根治术相比,完整骨性外耳道鼓室成形术在听力提高、干耳及消除不适症状方面有更好疗效。结论 胆脂瘤型中耳炎术中保留或重建骨性耳道对术后提高听力、尽早干耳及消除“根治腔病”疗效显著。     

外耳道癌8例

目的探讨早期外耳道癌的治疗。方法回顾性分析1995年3月至2006年1月的8例早期外耳道癌(鳞状细胞癌6例,基底细胞癌2例)。结果8例外耳道癌采用外耳道全切除术,6例术后加用放射治疗。3例鳞癌在术后半年至一年复发,行乳突切除术或颞骨次全切除术,1例死亡。5年生存率为88%。结论彻底切除肿瘤,辅以术后放疗是早期外耳道癌的治疗选择。     

外耳道胆脂瘤的临床特征和治疗（附25例报告）

目的探讨外耳道胆脂瘤的临床特征和治疗方法。方法回顾性分析我科1995～2007年收治的25例外耳道胆脂瘤患者的临床资料。结果对25例外耳道胆脂瘤患者根据不同病变范围采用不同的手术治疗,对8例外耳道病变范围小、骨质破坏较轻者采用外耳道清理术;17例因病变范围广、骨质破坏较重、胆脂瘤侵入中耳腔者采用乳突改良根治术或乳突根治术治疗。结论外耳道胆脂瘤可以造成广泛破坏,术前颞骨薄层CT扫描对诊断有较大帮助,应根据不同病变范围而采用不同的治疗方式。     

外耳道癌和中耳癌诊断、治疗的探讨

为探讨外耳道癌及中耳癌的诊断、治疗，对１７例患者的临床资料进行了分析，分析表明外耳道癌与中耳癌的症状相似，主要有耳内疼痛、耳漏及听力下降，大多数常两处同时受侵作为在原发病灶复致死外，尚未见其它因素对本病的预后有明显影响。鉴于手术治疗对局部解剖结构破坏性大，且对浸润范围较广泛的癌，多娄吓亦难以将其切除干净，故主张；（１０对局限于我耳道或中耳腔癌，可先行耳道切除或扩大乳突根治术加术后放疗；（２）对略超     

耳甲腔外耳道成形在乳突手术中的意义

胆脂瘤型及骨疡型中耳炎，是慢性中耳炎常见的两种类型，若处理不当，易发生严重并发症。其手术治疗的主要目的在于彻底清除病灶，保存或提高听力，防止并发症和预防复发。为探讨耳甲腔外耳道成形术对乳突根治术效果的影响，现将１９９４年８月－１９９９年８月期间，随访资料完整的１１２例乳突根治手术效果分析报告如下。1 资料与方法1．１ 临床资料 １１２例乳突手术病例，７８例（耳）行乳突根治术加耳甲腔外耳道成形术者为观察组，其中男５６例，女２２例（耳），年龄1２－６３岁，病程３－１８年，胆脂瘤型５７例，骨疡型２１例。各种…     

累及乳突的外耳道胆脂瘤手术方式

目的　探讨累及乳突的外耳道胆脂瘤手术方式的选择以及术中外耳道后壁保留的适应证、处理方法及意义。方法　回顾性分析2015～2018年收治我院耳科病房的外耳道胆脂瘤患者139例（147耳）。每例患者均接受保留或不保留外耳道后壁的乳突根治术。结果　根据胆脂瘤侵犯范围采取不同的手术方式，胆脂瘤清除同时行外耳道后壁修补术71耳，完壁式乳突根治术62耳，开放式乳突根治术14耳。术后均达到干耳。比较手术前后气导平均阈值（t =18.99，P＝0.03）及骨导平均阈值（t =6.48，P＝0.01）均有明显下降。术后随访1～2.5年，未见胆脂瘤复发。结论　外耳道胆脂瘤治疗应依据病变侵袭范围，采取不同的手术方式，只要胆脂瘤没有广泛累及乳突，都应尽量保留外耳道后壁完整性，采用完壁式乳突根治术，达到术后良好的治疗效果和长久的干耳状态。     

中耳恶性肿瘤33例临床分析

目的探讨中耳恶性肿瘤的临床特点和治疗策略。方法回顾性分析解放军总医院1997～2007年经治的33例中耳恶性肿瘤患者,其病理类型分别是25例鳞状细胞癌．5例腺癌,2例粘液表皮样癌及1例横纹肌肉瘤。结果按照Stell分期为Ⅰ期2例,Ⅱ期12例,Ⅲ期19例。8例行扩大的乳突根治术,19例行颢骨次全切除术,6例接受颞骨全切除术。以阔筋膜修复缺损的硬脑膜,以胸大肌皮瓣、胸锁乳突肌瓣、颞肌瓣等单独或联合修复术腔缺损。1例患者单独接受手术治疗,32例患者接受手术＋放疗的综合治疗。全组总的3年、5年生存率分别是85．2％、74．7％。有血性耳漏患者与无血性耳漏患者的3年生存率分别是74．1％和89．1％（P=0．049）。结论对中耳恶性肿瘤的患者采取扩大切除加术后根治性放疗可提高生存率,持续的血性耳漏可能是预后不良的表现。     

Carcinoma of the external auditory canal and middle ear: therapeutic strategy and follow up

BACKGROUND: Carcinomas of the external auditory canal (EAC) and the middle ear are rare and considered to have a poor prognosis. The recommended therapeutic strategy consists of surgical excision and postoperative radiotherapy. However, there are different opinions about the extend of the primary operation. PATIENTS AND METHODS: A series of 21 patients with carcinoma of the EAC and middle ear were treated at the ENT-Department of the Hospital Fulda from 1985 to 2003. Their records and radiologic findings were reviewed retrospectively with particular reference to tumor type and size, its relation to surrounding tissues, surgical procedures and radiation techniques. The tumors were staged according to the modified Pittburgh staging system for temporal bone carcinomas. The average follow-up time was 6.2 years (range 0.2 - 18.75). RESULTS: 17 patients suffered from carcinoma of the EAC, 4 carcinomas were primarily located in the middle ear. There were 15 squamous cell carcinomas, 3 adenoidcystic carcinomas, 2 adenocarcinomas and one mucoepidermoid carcinoma. 12 patients came primarily to our institution and were staged as follows: pT1 (n = 2), pT3 (n = 2), pT4 (n = 8). 8 patients showed up with recurrent or residual tumors (all of T3 or T4 stage). One patient could not be classified. In 5 cases the tumor was inoperable. These patients underwent combined chemoradiation therapy. All other 16 patients were operated and most of them received adjuvant radiation therapy. In the group of patients who were primarily operated overall 5-year survival rate was 100 %. In contrast, patients who's recurrent or residual tumors were resected had a 5-year survival rate of only 33 %. Patients who received combined chemoradiation therapy showed a 2-year survival rate of 75 %. CONCLUSION: Carcinoma of the EAC and middle ear should be treated primarily by a lateral or subtotal temporal bone resection stage dependent combined with a parotidectomy as well as a neck dissection. Local resection of the EAC is not sufficient, not even in T1 tumors. As from stage T2, in cases of recurrent tumor removal and questionable free margins as well as in cases with lymph node metastases an adjuvant radiation therapy should be added. The most important survival factor is removal of the primary tumor with histologically clear margins.     

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。     

Squamous cell carcinomas of the aryepiglottic fold: Therapeutic results and long-term follow-up

Three hundred fifteen patients with squamous cell carcinomas involving the aryepiglottic (A-E) folds were treated between January 1964 and December 1991. The age ranged from 39 to 87 years (mean, 62.4 years; median, 61.3 years) and the male-to-female ratio was 5:1 (54 women and 261 men). Symptom duration prior to diagnosis was 4.8 months. Eighty percent of patients had T3 and T4 lesions and 56.3% had neck metastases at presentation. Six patients (1.8%) had distant metastases and were excluded from this study. Clinically the tumors presented as either exophytic infiltrating lesions which were confined to the A-E fold (n = 57) or mucosally spreading tumors which extended to the lateral supraglottis or pyriform sinus (n = 258). Prior to 1978 preoperative radiation (3000 to 5000 cGy) was used. Higher doses of postoperative radiation (5000 to 6000+ cGy) were used thereafter. After 1982 the use of myocutaneous flaps for closure of partial laryngopharyngectomy defects was routine. Almost all NO neck disease was treated by radiation or surgery. Combined therapy was used in N1-N3 disease. One quarter of the patients had single-modality therapy (25.7%; 81 patients) with a cumulative 5-year disease-free survival of 53%. The remainder of the patients (n = 234) had combined therapy with a cumulative 5-year survival of 67.2%. The latter group had 163 conservation surgeries and 121 total laryngectomy resections. The 5-year disease-free survival for preoperative radiation with surgery (68%) and postoperative radiation with surgery (64%) was similar. Those treated by radiation alone had a 34% 5-year disease-free survival and those treated with surgery alone had a 61% 5-year disease-free survival. The cumulative locoregional control rate was 77%. The cumulative disease-free survival at 5,10,15, and 20 years is 66%, 57%, 55%, and 55%, respectively. Infiltrating tumors had a better disease-free survival (by more than 10%) than spreading tumors. The 5-year survival rates were separated well by clinical stages of tumors. In patients with T1 tumors the 5-year survival was 87%; in those with T2 tumors, 80%; in those with T3 tumors, 78%; and in those with T4 tumors, 41%. The survival rate was greater in those with NO tumors than in those with N+ tumors by 25% and greater in those with N1 tumors than in those with N2 + N3 tumors by an additional 18%. The overall complication rate was 26% and in 7.7% these were fatal. The salvage rate after single-modality therapy was equal for radiation and surgery (66.7%) and after combined therapy was better for surgery 53% (19/36) than radiation 24% (10/41). An incidence of distant metastases (16%), second primary tumors (8%), and death from intercurrent disease (11%) was documented. On a selected basis small T1N0 or T2N0 lesions can be treated equally well with single-modality therapy (>80%), but larger lesions or neck metastases require combined therapy with higher doses of postoperative radiation. Postoperative radiation reduced the complication rate and treatment-related fatalities, and increased the locoregional control and overall cure rates.     

Verrucous carcinoma of the temporal bone

Verrucous carcinoma is a highly differentiated variant of squamous cell carcinoma. In the literature, 11 cases of primary verrucous carcinoma of the temporal bone have been reported. We present a 48-year-old woman who had undergone radical mastoidectomy because of chronic otitis media 20 years ago; consequently, verrucous carcinoma occurred in the mastoid cavity. We discuss verrucous carcinoma of the temporal bone with the review of literature.     

Temporal bone resection.

It must be emphasized that the greatest impact of survival can only be obtained through an early diagnosis and a radical treatment program. Any granulation tissue must be sent for biopsy to rule out the possibility of malignancy in the setting of chronic otitis media. Once carcinoma is diagnosed, imaging studies must be obtained to define the extent of the tumor. Under diagnosis is the rule with these malignancies. Tumors limited to the external auditory canal can be adequately resected with a lateral temporal bone resection. Extension into the middle ear and mastoid aircell systems requires either a subtotal temporal bone resection or a lateral temporal bone resection with a radical mastoidectomy and petrousectomy. The inclusion of the petrous apex with the resection, as in a temporal bone resection, does not add to survival but increases morbidity. Radical postoperative radiation therapy is essential for maximum local control and survival with these malignancies.     

中耳癌20例报告

目的：提高临床对中耳癌的认识，做到及时诊断与治疗。方法：20例均先行手术治疗，其中14例采用扩大的乳突根治术，3例行侧颞骨切除术，3例行颞骨次全切除术；有颈淋巴结转移的3例同时行根治性颈淋巴结廓清术。术后均辅以放疗。结果：随访5～13年，3、5年生存率分别为55．0％(11／20)，45．0％(9／20)。结论：中耳癌手术治疗应根据其侵及中耳乳突的范围，以及有助于放射治疗发挥作用而选择不同的术式。     

Comparison of survival rates of patients with nasopharyngeal carcinoma treated with radiotherapy, 5-fluorouracil and vitamin A (“FAR” therapy) vs FAR therapy plus adjunctive cisplatin and peplomycin chemotherapy

The overall survival rate (OSR) of 36 patients with nasopharyngeal carcinomas (NPC) treated at Kyushu University hospital between 1983 to 1992 was analyzed. As primary treatment, 16 patients received a combination therapy of 5-fluorouracil, vitamin A, and radiation (FAR therapy); two patients received radiotherapy only; 18 patients received FAR therapy plus adjunctive systemic chemotherapy consisting of cisplatin and peplomycin. The radiation dose to the nasopharynx was 6000 to 7050 cGy while that to the neck was 4000–6000 cGy. The 5-year OSR of all the patients was 49%. Histological type (moderately differentiated squamous cell carcinoma) and patient age (≥ 55) were found to be significant prognostic factors for a worse OSR. Although survival decreased with increasing T stage, no significant difference was observed. The 5-year OSR of the patients treated with FAR therapy was 53% and was 51% with FAR therapy plus chemotherapy. Compared to FAR therapy alone, adjunctive chemotherapy did not increase OSR of the patients with NPC.     

Comparison of survival rates of patients with nasopharyngeal carcinoma treated with radiotherapy, 5-fluorouracil and vitamin A ("FAR" therapy) vs FAR therapy plus adjunctive cisplatin and peplomycin chemotherapy

The overall survival rate (OSR) of 36 patients with nasopharyngeal carcinomas (NPC) treated at Kyushu University hospital between 1983 to 1992 was analyzed. As primary treatment, 16 patients received a combination therapy of 5-fluorouracil, vitamin A, and radiation (FAR therapy); two patients received radiotherapy only; 18 patients received FAR therapy plus adjunctive systemic chemotherapy consisting of cisplatin and peplomycin. The radiation dose to the nasopharynx was 6000 to 7050 cGy while that to the neck was 4000-6000 cGy. The 5-year OSR of all the patients was 49%. Histological type (moderately differentiated squamous cell carcinoma) and patient age (S 55) were found to be significant prognostic factors for a worse OSR. Although survival decreased with increasing T stage, no significant difference was observed. The 5-year OSR of the patients treated with FAR therapy was 53% and was 51% with FAR therapy plus chemotherapy. Compared to FAR therapy alone, adjunctive chemotherapy did not increase OSR of the patients with NPC.     

Squamous cell carcinoma of the buccal mucosa: a retrospective analysis of 22 cases

We examined our institution's experience with 22 cases of previously untreated buccal squamous cell carcinoma via a retrospective chart review. Eleven of these patients had been treated with a combination of surgical excision and postoperative radiation therapy, 8 patients with surgical excision alone, and 3 patients with radiation therapy alone. The overall 3-year locoregional recurrence rate was 32% (n = 7). The 3-year survival rates were 82% after surgery plus radiation (9 of 11 patients), 63% after surgery alone (5 of 8), and 33% after radiation alone (1 of 3). Three-year T-category-specific survival rates were 100% for category T1 tumors (3 of 3 patients), 73% for T2 (8 of 11), 50% for T3 (3 of 6), and 50% for T4 (1 of 2). Although the small size of our study precluded any statistically significant conclusions, we believe that locoregional control and survival rates may be greater with surgical excision plus postoperative radiation than with treatment with either modality alone.