Malignant epithelial parotid tumours: A rational treatment policy
Malignant epithelial parotid tumours: A rational treatment policy
复制标题
腮腺恶性上皮肿瘤：合理的治疗策略
作者：
A. Ball;S. Fish;J. Thomas
由一名外科医生在11年内对271例患者进行了正式腮腺切除术。40例患者接受了恶性唾液腺肿瘤治疗（9例复发）。低级别肿瘤（45%）仅通过手术治疗，未治疗的高级别肿瘤（55%）通过手术和放疗治疗，手术前或手术后，取决于临床结果。手术的目的是清除肿瘤，尽可能保留面神经，并对经细胞学证实的可触及恶性淋巴结病和术中颈二腹肌淋巴结活检证实转移的高级别肿瘤进行根治性颈清扫术。4名患者因手术而持续面部无力。中位随访46个月时，2例患者出现局部复发。11例高级别肿瘤患者死于转移，但无低级别肿瘤患者死于转移。恶性肿瘤浸润导致面部无力的高级别病变患者和淋巴转移患者的预后显著差于无淋巴转移的患者。腮腺癌的局部控制可以通过正式的腮腺切除术和选择性放疗来实现，而不需要常规牺牲面神经。
Formal parotidectomy was undertaken in 271 patients by one surgeon over 11 years. Forty patients were treated for malignant salivary tumours (nine were recurrent). Low grade tumours (45 per cent) were treated by surgery alone, untreated high‐grade tumours (55 per cent) by surgery and radiotherapy, before or after operation, depending on clinical findings. The aims of surgery were to obtain tumour clearance, to preserve the facial nerve if possible, and to perform radical neck dissection for palpable malignant lymphadenopathy proven cytologically and for high‐grade tumours when intraoperative jugulodigastric lymph node biopsy confirmed metastasis. Four patients sustained facial weakness as a result of surgery. At a median of 46 months follow‐up two patients had developed local recurrence. Eleven patients with high‐grade but none with low‐grade tumours died from metastases. Patients with high‐grade lesions with facial weakness from malignant infiltration and those with lymphatic metastasis have a significantly worse prognosis than those without. Locoregional control of parotid cancers can be achieved by formal parotidectomy and selective irradiation without routine sacrifice of the facial nerve.