Casler J D, Conley J J
Otolaryngology Service-Head and Neck Surgery, Walter Reed Army Medical Center, Washington, DC 20307.
Otolaryngol Head Neck Surg. 1992 Apr;106(4):332-8. doi: 10.1177/019459989210600403.
Although adenoid cystic carcinoma may be found in multiple sites in the head and neck as well as other glandular sites throughout the body, nowhere is management of the disease more controversial than in the parotid gland. Here the facial nerve is at risk from both the disease and the treatment. Seventy-five cases of adenoid cystic carcinoma of the parotid were analyzed. Patients were placed in four groups, depending on the type of parotid surgery received as definitive therapy: (1) lateral lobectomy, (2) total parotidectomy, (3) radical parotidectomy without preoperative facial weakness, and (4) radical parotidectomy with preoperative facial weakness. Patients were assessed with regard to staging of the initial lesion, the status of surgical margins, and the use of postoperative radiotherapy. The incidence of local recurrence and distant metastases were also recorded. Survival statistics are presented for each group. Though associated with facial nerve sacrifice, radical parotidectomy appears to offer clear advantages in terms of long-term disease-free survival in patients with T2 and T3 lesions. The residual facial paralysis may be rehabilitated primarily or secondarily to reduce patient morbidity. Four of 16 patients (25%) with preoperative weakness achieved 10-year survival when radical parotidectomy was used. Obtaining clear margins at the initial setting appears to offer improved survival.
尽管腺样囊性癌可发生于头颈部的多个部位以及全身其他腺性部位，但该病的治疗在腮腺部位比其他任何部位都更具争议性。在此部位，面神经会受到疾病本身及治疗的双重威胁。对75例腮腺腺样囊性癌病例进行了分析。根据作为确定性治疗所接受的腮腺手术类型，将患者分为四组：（1）外侧叶切除术，（2）全腮腺切除术，（3）术前无面部无力的根治性腮腺切除术，（4）术前有面部无力的根治性腮腺切除术。对患者进行了初始病变分期、手术切缘情况以及术后放疗使用情况的评估。还记录了局部复发和远处转移的发生率。给出了每组的生存统计数据。尽管根治性腮腺切除术与牺牲面神经相关，但对于T2和T3期病变的患者，就长期无病生存而言，根治性腮腺切除术似乎具有明显优势。残余的面瘫可通过一期或二期修复来降低患者的发病率。16例术前有面部无力的患者中，有4例（25%）在接受根治性腮腺切除术后存活了10年。在初始手术时获得切缘阴性似乎能提高生存率。
