Kanatas A, Ho M W S, Mücke T
Leeds Teaching Hospitals and St James Institute of Oncology, Leeds Dental Institute and Leeds General Infirmary, LS1 3EX.
Department of Oral and Maxillofacial Surgery, Malteser Klinikum, Krefeld, North Rhine-Westphalia, Germany.
Br J Oral Maxillofac Surg. 2018 May;56(4):243-248. doi: 10.1016/j.bjoms.2018.01.021. Epub 2018 Mar 8.
Pleomorphic adenoma is the most common tumour of the parotid gland, and can recur after excision. Recurrent pleomorphic adenoma can be a challenge to treat, and has variable outcomes. The aim of this review was to summarise current thinking in its management, which may be helpful to clinical teams and could improve patients' health-related quality of life. We searched several online databases using the key terms pleomorphic adenoma, recurrent pleomorphic adenoma, parotid gland tumours, parotid surgery, radiotherapy and parotid pleomorphic adenoma, and parotid surgery outcomes. Information collected included sample size, recurrence rate, condition of the facial nerve, type of operation, adjuvant treatments associated with recurrence, and clinical outcome. We screened 2301 papers, of which 49 were eligible. There was no consensus among authors about management. There are few if any randomised studies, and so conclusions in most papers were based on coherent arguments. Pleomorphic adenomas of the parotid tend to recur after long intervals, with a propensity towards multifocal disease, and the risk of recurrence (which depends on the initial surgical technique) is higher when the initial operation was done at a young age, after enucleation, and if the initial margins were invaded. Published conclusions suggest that the accepted management varies from observation in selected cases to total parotidectomy with or without postoperative radiotherapy.
多形性腺瘤是腮腺最常见的肿瘤，切除后可能复发。复发性多形性腺瘤的治疗颇具挑战，且预后各异。本综述的目的是总结其当前的治疗思路，这可能有助于临床团队，并能改善患者的健康相关生活质量。我们使用关键词“多形性腺瘤”“复发性多形性腺瘤”“腮腺肿瘤”“腮腺手术”“放射治疗”以及“腮腺多形性腺瘤”和“腮腺手术结果”检索了多个在线数据库。收集的信息包括样本量、复发率、面神经状况、手术类型、与复发相关的辅助治疗以及临床结果。我们筛选了2301篇论文，其中49篇符合要求。作者们对于治疗方法并未达成共识。几乎没有随机研究，因此大多数论文的结论基于合理的论证。腮腺多形性腺瘤往往在较长时间间隔后复发，倾向于多灶性病变，并且当初次手术在年轻时进行、采用剜除术以及初次手术切缘受侵时，复发风险（取决于初始手术技术）更高。已发表的结论表明，公认的治疗方法从对特定病例的观察到行腮腺全切除术并辅以或不辅以术后放疗不等。
