T1或T2颞骨恶性肿瘤的循证外科治疗

Department of Otology and Skull Base Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai 200031, China

Objectives/Hypothesis: To determine whether aggressive surgical management is more effective than local canal resection (LCR) for early-stage temporal bone malignancies. Study Design: Retrospective study. Methods: Forty-three cases of early-stage external auditory canal (EAC) carcinoma who received surgical management between 1993 and 2011 were reviewed. Preoperative computed tomography, enhanced magnetic resonance imaging, pure-tone audiometry, and biopsy were performed. Patients underwent either LCR or lateral temporal bone resection (LTBR). Postoperative pathologic examinations were conducted on all specimens, including assessment of margin status. The duration of the postoperative follow-up period ranged from 6 months to 18 years. Results: Of 26 patients who underwent LCR, 10 were stage T1 and 16 were T2. Positive surgical margins were identified in 14 patients. During the follow-up, 12 patients developed recurrence. Of 17 patients who underwent LTBR with superficial parotidectomy, six were stage T1 and 11 were T2. The lateral EAC margins were negative in all 17 patients. In 2/6 T1 patients and in 5/11 T2 patients, tumor cells were identified deep within the EAC cartilage and parotid gland. All of the patients who underwent LTBR survived without evidence of recurrence. Conclusions: LTBR with superficial parotidectomy offers the greatest chance of cure for early-stage EAC carcinoma. Intraoperative frozen sections are necessary to determine the tumor-free lateral EAC margins. Postoperative radiotherapy is not strongly recommended for early-stage EAC carcinoma after LTBR. Laryngoscope, 2013 Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

Dai, C.; Department of Otology and Skull Base Surgery, Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai 200031, China; email:cfdai66@yahoo.com.cn