Ball A B, Rajagopal G, Thomas J M
Westminster Hospital, London.
Ann R Coll Surg Engl. 1990 Jul;72(4):247-9.
Formal parotidectomy was performed in 120 patients by one surgeon over 7 years. Eighteen patients were referred with malignant salivary tumours (eight recurrent). Low-grade tumours (LGT) were treated by surgery alone; untreated high-grade tumours (HGT) were treated by pre- or post-operative radiotherapy according to clinical findings. The aim of surgery was to obtain tumour clearance, to preserve the facial nerve where possible, and to perform radical neck dissection for HGT when peroperative jugulodigastric lymph node biopsy confirmed metastasis. Five patients (all HGT) with complete facial palsy due to tumour underwent radical parotidectomy; of the remainder, only one suffered further deterioration of facial nerve function after surgery. After 5 years median follow-up from presentation, four patients with HGT have died from metastases; one has developed local recurrence. No patient with LGT has died or developed local recurrence. The survival difference between patients with HGT and LGT is statistically significant (P less than 0.05). A logical management policy for malignant parotid tumours requires knowledge of tumour grade.
在7年时间里，一位外科医生为120例患者实施了腮腺全切除术。18例患者因涎腺恶性肿瘤前来就诊（其中8例为复发性肿瘤）。低级别肿瘤（LGT）仅接受手术治疗；未接受治疗的高级别肿瘤（HGT）则根据临床检查结果接受术前或术后放疗。手术的目的是清除肿瘤，尽可能保留面神经，并且当术中颈静脉二腹肌淋巴结活检证实有转移时，对HGT患者进行根治性颈清扫术。5例因肿瘤导致完全性面瘫的患者（均为HGT）接受了根治性腮腺切除术；其余患者中，只有1例术后面神经功能进一步恶化。从确诊开始中位随访5年后，4例HGT患者死于转移；1例出现局部复发。没有LGT患者死亡或出现局部复发。HGT患者和LGT患者之间的生存差异具有统计学意义（P小于0.05）。针对腮腺恶性肿瘤的合理治疗策略需要了解肿瘤分级。
