涎腺腺樣囊性癌66例臨床分析

摘要：目的 探討涎腺腺樣囊性癌部位、分期、治療方法與復發及轉移關系。方法 對66例涎腺腺樣囊性癌患者的病歷資料作臨床分析。結果 腮腺23例，舌下腺14例，頜下腺6例，腭部12例，頰部8例，舌根3例。治療方法，腮腺腺腺樣囊性癌行全腮腺摘除13例，腮腺淺葉+部分深葉摘除9例，腮腺淺葉摘除1例；保留面神經18例，面神經切除5例；行肩胛舌骨上淋巴清掃15例。頜下腺、舌下腺、頰部、舌根腺樣囊性癌均行腺體及局部擴大切除+同側肩胛舌骨上淋巴清掃術；腭部腺腺樣囊性癌行局部擴大切除+同側肩胛舌骨上淋巴清掃術6例，單純行局部擴大切除2例；術后放療60例，同時行術后放化療3例。術后復查3～10年，局部復發8例，遠處轉移9例。臨床分期，Ⅰ期10例、Ⅱ42期例、Ⅲ期8例、Ⅳ期6例。結論 頜下腺、舌下腺、頰部、舌根、腭部腺樣囊性癌應同期行局部擴大切除+同側肩胛舌骨上淋巴清掃術；腮腺腺腺樣囊性癌如無神經受損癥狀及術中腫物與神經無明顯粘連可保留面神經，術前檢查如淋巴結無明顯腫大可不作頸淋巴清掃術。術后均應行放療。術后化療效果如何本組病例不明確。Ⅲ、Ⅳ期較Ⅰ、Ⅱ期復發、轉移為高。

關鍵詞：涎腺腺樣；囊性癌；手術放療；復發轉移

Abstract：Objective Find the probable relationship between the tumor site，stage，strategy and the recurrence，metastasis of adenoid cystic carcinoma. Methods 66 cases of adenoid cystic carcinoma were researched in the retrospective way，including 23 cases in parotid，14 cases in sublingual gland，6 cases in submandibular gland，12 cases in pallet gland，8 cases in cheek mucosa and 3 cases in back-lingual.13 of 23 cases of parotid gland adenoid cystic carcinoma were treated by total resection of parotid，9 cases of it were treated by partially resection with reservation of partial deep lope，while 1 case with all deep lope.in all these 23 cases，facial nerve was successfully reserved in 18 cases，while other 5 cases had to be sacrificed.15 of 23 cases had regional neck dissect at the same time.6 cases of pallet adenoid cystic carcinoma were totally dissect with regional neck dissection at the same time while 2 cases without；Other 35 cases of 66 adenoid cystic carcinoma were operated by enlarging resection and regional neck dissection.60 cases of adenoid cystic carcinoma undergo radiation therapy after surgery while 3 cases at the same time.Clinical staging were 10 cases of stage I，42 cases of stage II，8 cases of stage III，6 cases of stage IV. Results All patients represent in following 3～10 years，8 cases recurrent，9 cases metastasis.Higher recurrent and metastasis rate were observed in stage III and IV cases. Conclusion Adenoid cystic carcinoma in sublingual gland，submandibular gland，pallet gland，cheek mucosa and back-lingual should be totally dissected with regional neck dissection at the same time；Facial nerve could be reserved if not be compressed and not adhesive to tumor.Regional neck dissection is not necessary if lymph node is clinically negative.Radiation therapy is recommended in all cases，but necessity of post surgery chemical therapy is not sure.

Key words：Silvery land；Adenoid cystic carcinoma；Surgery；Radiation therapy；Chemical therapy

涎腺腺樣囊性癌（salivaryadenoidcysticcarcino2a，SACC）占涎腺腫瘤的10%，是發生于涎腺的惡性腫瘤，其特點是生長緩慢，具有廣泛的侵襲性，特別是腫瘤嗜好侵犯神經并順其擴展，且可通過血行遠處轉移[1]。臨床上表現為容易復發，易向遠處發生轉移，遠期療效不佳，治愈率低。本文對我院自2004年1月～2011年5月以來收治的66例涎腺腺樣囊性癌患者進行回顧性分析，旨在對其發生部位、分期、治療方法與復發及轉移關系作一初步探討，以期總結出一些經驗供臨床參考。……