- 期刊
Carcinoma of the External Auditory Canal and Middle Ear
外耳道及中耳癌
摘要
台北及台中榮民總醫院自民國59牪月至77年12月共有53例外耳道及中耳癌，期中男性49例，女性4例，年齡介於5和80歲之間，中值為59歲。原發部位之分布為源自外耳道32例，中耳10例，剩下11例因腫瘤大到充滿整個外耳道及中耳，難以判定其真正起源。病理型態以鱗狀上皮癌最多，佔全部的85％，大多數病人曾有慢性中耳炎或外耳炎之病史。約三分之二的病人在診斷時已是局部晚期，其中有6例合併局部淋巴轉移，有 3例後來發生遠處轉移。治療方式主要是手術加放射線治療，共有31例。單獨手術治療9例，單獨放射線治療8例(含3例未能接受全程劑量)，有5例拒絕任何治療。局部控制率及存活率以合併手加放射治療最佳，整組病人之五年存活率為33％，對早期及晚期病灶之存活率分別為51％和23％，具有統計學上差異(P＜0.05)。手術治療併發症以出血及感染最常見，放射治療則以骨壞死最多。本文共有8例嚴重併發症，後來都導致死亡。在34例死亡，因腫瘤而死的佔72％。源自外耳道及中耳的癌症發生率很低，但侵犯性強，單獨手術或放射線治療是不夠的。根除手術加上手術後放射線治療，是一致被接受的標準治療，也是唯一可能達到根治的方式。我們建議合併療法及努力早診斷，才能提高疾病控制率及存活時間。
關鍵字
無資料並列摘要
Fifty-three patients with carcinoma arising in the external auditory canal and/or middle ear seen at Veterans General Hospitals, Taipei and Taichung in the period between January 1970 and December 1988 were retrospectively re-viewed. There were 49 males and 4 females. Their ages ranged from 5 to 80 years, the average being 58 and the median 59 years. In 10 patients the primary site of the tumor was located in the middle ear, in 32 patientsit was the external auditory canal, and in the remaining 11, both areas. The most common cancer which occurred in this area was the squamous cell type, accounting for 85% of out cases. Themajority of patients had an otorrhea history with duration from 6 months to more than 40 years. Nine patiients received surgery alond, 8 irradiation alone, 31 a combination of surgery and radiotherapy. Initial complete regression of the tumor was noted in 100% of the combined therapy group. This was better than surgery (56%) or irradiation alone (60%). Bleeding and infection caused by surgery, and osteonecrosis caused by radiation were the most frequent and severe complications. The actual 5-year survival rate was 33%. Life table analysis show-ed that only the extent of the disease affected survival significantly. The 5-year suvival rates were 23% and 51% for advanced and early stages respectively (peration or radiotherapy alone, but the benefit did not reach a significant level (p=0.09). In summary, radical surgery plus postoperative radiation therapy is the long-term survival rate has remained poor. Early diagnosis is pertinent, and com-bined therapy is recommended.
延伸閱讀
- 詹維軒、梁家光（2003）。外耳道多形性腺瘤。台灣耳鼻喉頭頸外科雜誌，38(s_1)，22-26。https://doi.org/10.6286/2003.38.s_1.22
- Pan, C. W., Yuan, C. H., & Chen, R. F. (2017). 外耳道多型性腺瘤－案例報告. 台灣耳鼻喉頭頸外科雜誌, 52(2), 83-86. https://doi.org/10.6286/2017.52.2.83
- 侯士欽、葉文堯、榮蘊智（2008）。以中耳及外耳道腫塊爲表現之罕見鼻咽癌病例。台灣耳鼻喉頭頸外科雜誌，43(5)，149-153。https://doi.org/10.6286/2008.43.5.149
- 邱泰茂、趙文元（1992）。惡性外耳炎。當代醫學，(227)，707-709。https://doi.org/10.29941/MT.199209.0006
- 楊政謙、林鴻清、徐銘燦、陳一豪（1994）。外耳道異物。中華民國耳鼻喉科醫學會雜誌，29(6)，472-476。https://doi.org/10.6286/1994.29.6.472