本文選題：顳骨惡性腫瘤 + 頸靜脈孔�。� 參考：《復(fù)旦大學(xué)》2013年碩士論文

【摘要】：目的：了解侵及頸靜脈孔顳骨惡性腫瘤的臨床表現(xiàn),影像學(xué)特征,手術(shù)方式及預(yù)后,探討術(shù)前評(píng)估,圍手術(shù)期處理、手術(shù)方式對(duì)全切病變及預(yù)防并發(fā)癥的意義。 資料和方法：回顧性分析復(fù)旦大學(xué)附屬眼耳鼻喉科醫(yī)院2006年10月至2012年10月手術(shù)治療的10例侵及頸靜脈孔顳骨惡性腫瘤,病理類(lèi)型包括6例鱗狀細(xì)胞癌,2例腺樣囊性癌,1例耵聹腺癌,1例軟骨肉瘤,術(shù)前檢查包括聽(tīng)力檢查、面神經(jīng)電圖(ENoG)、硬管喉鏡、高分辨率顳骨CT(HRCT)、增強(qiáng)頭頸部核磁共振(MRI)。對(duì)于腫瘤血供豐富的病例,行數(shù)字減影血管造影(DSA)了解血供情況,甚至行血管栓塞。統(tǒng)計(jì)分析臨床癥狀、體格檢查、聽(tīng)力及影像學(xué)檢查、手術(shù)方式及隨訪資料。最常見(jiàn)的癥狀是傳導(dǎo)性聾、其次是耳流膿、耳痛。最常見(jiàn)的侵及部位是外耳道、中耳、面神經(jīng)。3例患者術(shù)前在外院被誤診。5例患者采用改良的顳下窩入路,5例患者采用乳突頸部聯(lián)合入路手術(shù)。 結(jié)果：隨訪時(shí)間2-79月,平均26.3月,隨訪期間,4例死亡,生存率為60%。1例患者出現(xiàn)術(shù)后面癱(H-B IV),未做面神經(jīng)移植,1例患者行血管栓塞后出現(xiàn)聲嘶、吞咽困難、伸舌偏向和抬臂困難,另有1例患者放療后出現(xiàn)抬臂困難加重,1例患者術(shù)后腦脊液漏修,保守治療后恢復(fù)。 結(jié)論：侵及頸靜脈孔的顳骨惡性腫瘤,發(fā)病率低,臨床表現(xiàn)復(fù)雜且無(wú)特異性,容易漏診或誤診；頸靜脈孔解剖復(fù)雜,手術(shù)難度大,應(yīng)該根據(jù)腫瘤的位置、大小、侵及范圍、聽(tīng)力水平、后組顱神經(jīng)功能以及術(shù)者的經(jīng)驗(yàn),選擇個(gè)性化的手術(shù)方式,術(shù)中盡量保存后組顱神經(jīng)和面神經(jīng)的功能；侵及頸靜脈孔的顳骨惡性腫瘤預(yù)后差,特別是鱗癌,復(fù)發(fā)腫瘤預(yù)后更差,首次治療應(yīng)盡可能完全切除病變,防止復(fù)發(fā),應(yīng)輔助放療或化療。
[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.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類(lèi)號(hào)】：R739.6

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