腮腺惡性腫瘤之回顧分析：以某醫學中心為例

Malignant Parotid Tumor: A Retrospective Analysis in a Medical Center in Central Taiwan

王清源(Ching-Yuan Wang) ； 蔡佳宏(Chia-Hung Tsai) ； 花俊宏(Chun-Hung Hua) ； 蔡銘修(Ming-Hsui Tsai) ； 鄭紹隆(Shao-Lung Cheng)

《Mid-Taiwan Journal of Medicine》 8卷s_2期 (2003/12) Pp. s98-s101

https://doi.org/10.6558/MTJM.2003.8(s_2).5

摘要

目的：腮腺腫瘤是國人唾液腺疾病中並非少見的一種，但臨床上很難依症狀來區分良性及惡性腮腺腫瘤。根據國外的文獻指出，惡性腮腺腫瘤約佔所有腮腺腫瘤的15%至30%。回溯分析本院近五年內罹患腮腺腫瘤病患之資料顯示，惡性腮腺腫瘤之發生率低於國外，且臨床症狀、病理型態分佈亦不同於國外之報告。
方法：自民國88年1月至92年9月近五年間，針對因腮腺腫瘤而在本院接受腮腺切除手術，且病理報告為惡性腮腺腫瘤者，分析探討其臨床症狀、病理型態及惡性腫瘤發生率、處理原則、預後，並回顧相關文獻。
結果：共計有152名腮腺腫瘤患者接受手術治療，其中惡性腫瘤患者有18名。男性14名，女性4名。年齡分佈由16歲到81歲，平均年齡為49歲，平均腫瘤存在12.4個月。平均追蹤時間22.4個月其中adenocarcinoma有5位（27%），lymphoma有4位（22%），adenoid cystic carcinoma有3位（17%），mucoepidermoid carcinoma有3位（17%），carcinoma ex pleomorphic adenoma有3位（17%）。在臨床症狀方面以耳下無痛堅硬腫塊、快速變大的腫瘤及顏面麻痺較為常見。術中有實施冷凍切片者有16位，其中切片報告為惡性者有12位。術後追蹤至今，18位患者中仍有16位存活，存活率為88.9%。
結論：本院所統計的惡性腫瘤發生率約為11%，低於國外之發生率，而且腫瘤細胞型態也和國外的文獻報告有所差異。惡性腮腺腫瘤患者，主要的臨床症狀包括快速出現或是已存在數年的腫瘤等，至於腫瘤的大小、是否疼痛、有無面神經麻痺和其是否為惡性，並沒有绝對的相關性。術中實施冷凍切片手術仍有其必要性。

關鍵字

惡性腮腺腫瘤

並列摘要

Objectives: Parotid tumor is not an uncommon disease of salivary glands in Taiwan. However, distinguishing between benign and malignant tumors is difficult preoperatively. According to the literature, the incidence of malignancy is 15% to 30% of all parotid tumors. In this study, we analyzed the clinical symptoms and signs, postoperative pathological reports, treatment entities and outcome of patients with malignant parotid tumor in our hospital in the past 5 years, and tried to find for correlations among them.
Methods: The clinical records of patients with parotid tumor who received operation in our hospital between January 1999 and September 2003 were retrospectively reviewed.
Results: A total of 152 parotidectomies were studied, including 18 cases with malignant parotid tumor. The ages ranged from 16 to 81 years (average, 49). The average duration of existing malignant parotid tumors was 12.4 months. Among the 18 cases of malignancy, there were 14 men and 4 women. Five cases were adenocarcinoma (27%), 4 cases were lymphoma (22%), 3 cases were adenoid cystic carcinoma (17%), 3 cases were mucoepidermoid carcinoma (17%) and 3 cases were carcinoma ex pleomorphic adenoma (17%). The most common symptoms and signs were infrauricular, painless and firm masses, rapidly enlarging masses and facial palsy. The frozen section was made intraoperatively in 16 patients, and 12 of them had positive results.
Conclusions: The malignancy rate of parotid tumor was 11% in this study, which is lower than that reported in the literature. The most common pathology was adenocarcinoma. The most common symptoms were rapid-onset tumor and tumors existing for years but rapidly increasing in size before operation. Malignancy can not be predicted by the size of tumor, by pain or tenderess or facial palsy. The frozen section intraoperatively was quite reliable and is recommended.

並列關鍵字

malignant parotid tumor