本文選題：癌癥　切入點：外耳道　出處：《山東大學》2015年碩士論文　論文類型：學位論文

【摘要】：研究目的：探討外耳道及中耳癌的臨床表現(xiàn)、診斷方法、治療策略和影響預(yù)后的危險因素,以期規(guī)范該病治療措施,提高患者生存時間和生存質(zhì)量。研究方法：回顧性分析我院2005年4月-2014年2月收治并經(jīng)病理證實的60例外耳道及中耳癌患者的完整臨床資料和隨訪信息。分析內(nèi)容包括臨床表現(xiàn)、病理類型、影像學表現(xiàn)、臨床分期、治療方案等。采用K-M法繪制各組患者的生存曲線,用COX比例風險模型分析不同危險因素與生存時間的相關(guān)性,選用的危險因素包括性別、年齡、T分期、手術(shù)切緣、淋巴結(jié)轉(zhuǎn)移、面癱、病理類型等。結(jié)果：根據(jù)Pittsburgh分期標準,T1期18例,T2期7例,T3期9例,T4期26例。其中,26例行顳骨外側(cè)切除術(shù),30例行顳骨次全切除術(shù),2例于外院行擴大乳突根治術(shù),1例行單純化療,1例行單純放療。全組患者5年總生存率、無復發(fā)生存率分別為67.3%、59.5%,早期(T1、T2期)病例5年生存率、無復發(fā)生存率均為100%,T3期病例5年生存率、無復發(fā)生存率分別為76.2%、62.2%,T4期病例的5年生存率、無復發(fā)生存率分別為32.9%、27.3%。手術(shù)加放療組與單純手術(shù)組病例的5年生存率分別為84.7%、51.3%,5年無復發(fā)生存率分別為70.0%、50.8%。在各危險因素中,T分期、手術(shù)切緣、有無面癱、有無硬腦膜受累、病理類型對于預(yù)后有明顯影響。結(jié)論：1、外耳道及中耳癌十分罕見,早期患者的預(yù)后情況良好,但是晚期患者的預(yù)后較差,因此早期診斷和治療對于該病的預(yù)后至關(guān)重要。2、Pittsburgh分期標準是一種科學有效的分期手段,其分期和預(yù)后相關(guān),對于指導手術(shù)方式的選擇具有重要意義。3、我們推薦的最佳治療方案為手術(shù)治療聯(lián)合術(shù)后放療。早期患者推薦顳骨外側(cè)切除術(shù),晚期患者推薦顳骨次全切除術(shù),部分可以采用顳骨外側(cè)切除術(shù),不推薦采用局部切除、乳突根治術(shù)、顳骨全切除術(shù)等。4、T分期為晚期、面神經(jīng)受累、手術(shù)切緣陽性、硬腦膜受累、病理為鱗癌為預(yù)后不良的可能危險因素。硬腦膜受累和病理為鱗癌為生存率的獨立危險因素,術(shù)后輔助放療為保護因素。
[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.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R739.61

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