Moffat D A, Grey P, Ballagh R H, Hardy D G
Department of Otoneurological and Skull Base Surgery, Addenbrooke's Hospital, Cambridge, United Kingdom.
Otolaryngol Head Neck Surg. 1997 Jun;116(6 Pt 1):617-23. doi: 10.1016/S0194-59989770237-7.
The aim of this study was to assess the surgical results of a series of patients from this unit who underwent extended temporal bone resection for recurrent squamous cell carcinoma as a salvage procedure.
The surgical records of 15 patients were analyzed in detail. Each patient had salvage surgery in the form of an extended temporal bone resection with supraomohyoid block dissection, dural grafting, and free microvascular forearm or scalp rotation flap repair for recurrent squamous cell carcinoma in a radical mastoid cavity.
Radical surgery yielded a 47% 5-year survival. Twenty-nine percent of the survivors had temporal lobe involvement that necessitated a partial excision of the temporal lobe of the brain. Histologic evidence of local lymph node involvement in the supraomohyoid neck dissection was present in 13% of cases. Those who died did so in the first postoperative year. All those with poorly differentiated tumors died. The survivors had well or moderately differentiated tumors.
Radiotherapy alone or partial temporal bone resection, most commonly a radical mastoidectomy with or without preoperative or postoperative radiotherapy is used by the majority of otolaryngologists in treating squamous cell carcinoma of the temporal bone. The 5-year survival rate after this treatment remains depressingly low and the prognosis gloomy, particularly for advanced tumors. The findings in this series of extended temporal bone resections as salvage surgery in recurrent disease is encouraging, and radical surgery combined with radiotherapy from the outset may give much better 5-year survival figures in the future than the conventional partial temporal bone resection and radiotherapy.
本研究旨在评估本单位一系列因复发性鳞状细胞癌而接受扩大颞骨切除术作为挽救性手术的患者的手术结果。
详细分析了15例患者的手术记录。每位患者均接受了挽救性手术，手术方式为扩大颞骨切除术联合肩胛舌骨肌上颈淋巴结清扫术、硬脑膜移植术，以及采用游离微血管前臂皮瓣或头皮旋转皮瓣修复根治性乳突腔内的复发性鳞状细胞癌。
根治性手术的5年生存率为47%。29%的幸存者有颞叶受累，需要部分切除脑颞叶。13%的病例在肩胛舌骨肌上颈淋巴结清扫术中存在局部淋巴结受累的组织学证据。死亡患者均在术后第一年死亡。所有低分化肿瘤患者均死亡。幸存者的肿瘤为高分化或中分化。
大多数耳鼻喉科医生在治疗颞骨鳞状细胞癌时，单独使用放疗或进行部分颞骨切除术，最常见的是根治性乳突切除术，无论有无术前或术后放疗。这种治疗后的5年生存率仍然低得令人沮丧，预后不佳，尤其是对于晚期肿瘤。本系列关于扩大颞骨切除术作为复发性疾病挽救性手术的研究结果令人鼓舞，从一开始就将根治性手术与放疗相结合，未来可能会比传统的部分颞骨切除术和放疗带来更好的5年生存率。
