【作者】 蔡以理； 王中和； 陆顺娟；

【Author】 Cai Yili Wang Zhonghe Lu Shunjunan Shanghai Second Medical University School of Stomatology

【机构】 上海第二医科大学附属第九人民医院口腔颌面外科放疗室；

【摘要】 <正>目的:分析涎腺恶性淋巴上皮病(Malignant lymphoepithelital lesions MLEL)的临床特点、疾病的发展规律、治疗方法及转归。临床资料及方法:本组收集了自1989年至1997年来放疗的涎腺恶性淋巴上皮病共21例。其中原发于腮腺18例,腭部2例,颌下腺1例。男性5例,女性16例,更多还原

【Abstract】 Aim:To analysis for clinical characteristic, evolution and prognostic of Malignant lymphoepithelial lesions (MLEL) in salivary gland. Method: Durng 1989～1997, we treated 21 cases of MELI in salivary gland. The primary site is parotid in 18 cases, palate small salivary gland in 2 cases and submandibular gland in 1 case. There were 5 men and 6 women with an age rage of 31 and 74 years (median, 41 years). For stage Ⅱ, Ⅲ, mass dissection and superficial or whole parotidectomy were carried out. And facial nerve was protected in the whole way, when it had not been invaded. We extract 3～25 lymph notes to exam in pathology for every neck dissection specimen For stage Ⅳ, neck dissection may be included, when it was necessary. All patients were irradiated on primary site or including ipsilateral neck 2～9ws later after operation, except 2 cases irradiated after recurrence. Tumor doses were 5203cGy in average. Result: In our group 3/21 patients has recurrent benign lymphoepithelial lesion history (BLEL). The shortest duration form the recurrence to specific diagnosis was 6m, and the longest was 2 years. The Ⅱ, Ⅲ, Ⅳ stage cases were 8 (42.9%), 3(15.3%), 10(47.6), respectively. All of Ⅱ, Ⅲ stage cases were No. The cases with positive lymph nodes were 10/21 (47.61%). 5 years survival ratio was 56.31%, for Ⅱ, Ⅲ, Ⅳ stage was 86.68%, 66.67%, 33.3% respectively, analysis by Life Table. And test with Wilocoxon (Gemhan) statistic, p=0.2789, means there was no specific difference among each group. In the group, 5 patients dead and 2 lost follow up (counted in dead); mortality was 33.31%, all of them were Ⅳ stage, died in MELE, superior and middle cervical metastasis were found in 4 of those patients with parotid MELE, and 4 cases had neck dissected and ipsilateral neck irradiated. Recurrence were found in 7/21(33.3%), 5 of 7 cases were Ⅳ with N2 or N3, 2 of 7 primary sites were on plates in early or middle stage either with positive or deficient edge 6 of 7 recurrence occurred on neck. The duration from first treatment to recurrence was 20.7m in median, the shortest was 5m and the longest was 65m, among them the recurrence occurred shorter than 20m in 5 cases. After comprehensive treatment, 3 patients are survival and 3 cases dead. One lost follows up after chemotherapy. Metastasis occurred on 4 patients in Ⅳ stage (T4N2MO), with positive middle cervical lymph nodes in 3 cases treated with neck dissection before. Conclusion: Recurrent BLEL intends to develop to malignant lesion. Superior and middle deep cervical lymph nodes metastasis were not unusual in Ⅳ stage patients. Neck dissection and irradiation should be carried out on these patients, especially for those with N2. The peak time of recurrence is 2 years after first treatment, and during the time, the tumor proliferates rapidly. Follow up should be kept on closely. Active comprehensive treatment should be carried out on recurrent patients. Some of them may acquire good effects. For p更多还原