《耳鼻喉科室》課件耳鼻喉 耳部腫瘤

1、耳部腫瘤Tumors of Ear 鄭州大學(xué)第一附屬醫(yī)院耳科 郝少娟Lesions of the earBenign neoplastic lesions of the external ear1Malignant neoplasms of the external ear2Benign neoplastic lesions of the middle and inner ear3Malignant neoplasms of the middle and inner ear4Company LogoAnatomy of EarCompany Logo外耳良性腫瘤 外耳道乳頭狀瘤 papillo

2、ma of extenal canal 男性好發(fā)，反復(fù)挖耳所致 出血、阻塞感、聽(tīng)力減退 耳道多發(fā)或單發(fā)桑葚狀腫物，質(zhì)地較硬 手術(shù)切除：腫瘤邊緣正常皮膚1mm以上Company Logo外耳良性腫瘤 耳廓和外耳道血管瘤 hemangioma 主要位于耳廓 毛細(xì)血管瘤 capillary hemangioma 海綿狀血管瘤 cavernous hemangioma 蔓狀血管瘤arterial racemosum hemangioma 非手術(shù)治療：冷凍、激光、放射、局部注射硬化劑 手術(shù)治療Company Logo外耳良性腫瘤 耵聹腺瘤 ceruminoma 好發(fā)于外耳道軟骨部耵聹腺分布區(qū) 發(fā)病緩慢，

3、腫瘤較大可致聽(tīng)力障礙 外耳道后下局限性隆起，黃豆大小，表面皮膚正常 手術(shù)治療：易惡變，切除范圍包括腫瘤邊緣至少0.5cmCompany Logo外耳良性腫瘤 外耳道骨瘤 exostosis 早期無(wú)癥狀，腫瘤體積增大可出現(xiàn)耳悶、聽(tīng)力下降 外耳道骨部球星隆起，皮膚正常，質(zhì)硬 CT顯示外耳道骨性段骨樣密度增生 手術(shù)治療Company Logo外耳惡性腫瘤 腺樣囊性癌 adenoid cystic carcinoma，ACC 低度惡性腫瘤，生長(zhǎng)緩慢 癥狀不典型，持續(xù)多年，易復(fù)發(fā) 耳痛、耳道腫塊，聽(tīng)力下降、耳鳴、流膿、耳癢 耳道皮下隆起，界限不清，質(zhì)硬，觸痛，肉芽，潰瘍 手術(shù)治療：徹底切除為主，輔助放療

4、Company Logo外耳惡性腫瘤 惡性黑色素瘤adenoid cystic carcinoma 低度惡性腫瘤，生長(zhǎng)緩慢 癥狀不典型，持續(xù)多年，易復(fù)發(fā) 耳痛、耳道腫塊，聽(tīng)力下降、耳鳴、流膿、耳癢 耳道皮下隆起，界限不清，質(zhì)硬，觸痛，肉芽，潰瘍 手術(shù)治療：徹底切除為主，輔助放療Company Logo黑色素瘤 MelanomaDark and flat macule with variegated colors. Its borders are irregular, with indentations and notches.Pattern encompasses a radial growt

5、h phase (located at the dermalepidermal junction) and a vertical growth phase with invasion of the adjacent dermis (lower part of figure; haematoxylin and eosin stain, magnification 400)Company Logo鱗狀細(xì)胞癌Exophytic, hyperkeratotictumor with central ulceration, accompanied with seroanguinous exudate.mi

6、ddle and lower areas have islands and strands of invasive squamous carcinoma. Superficial sampling might not reach the underlying tumour risking underdiagnosis and a well-differentiated invasive tumour might closely resemble a reactive squamous proliferation, and risk underdiagnosis (haematoxylin an

7、d eosin stain, magnification 400).Squamous cell carcinoma (SCC)Company Logo基底細(xì)胞癌Erythematous papule with indicated pearly border. Remark the central ulceration of the retroauricular located lesion.Islands of tumour cells are surrounded by a row of elongated cells that resemble basal cells of the nor

8、mal epidermis (haematoxylin and eosin stain, magnification 400).Basal cell carcinoma (BCC)Company Logo中耳癌carcinoma of middle ear Company Logo中耳癌 占全身癌的0.06%，占耳部腫瘤的1.5% 以鱗狀上皮癌最多見(jiàn) 40-60歲為好發(fā)年齡 性別與發(fā)病率無(wú)顯著差別病因80%有長(zhǎng)期慢性化膿性中耳炎病史電離輻射、理化刺激、乳頭狀瘤惡變Company LogoPrimary squamous carcinoma ofmiddle ear Company Logo中耳

9、癌-臨床表現(xiàn) 出血：耳道無(wú)痛性出血 耳痛 聽(tīng)力障礙 同側(cè)周?chē)悦姘c 張口困難：侵犯顳頜關(guān)節(jié)或翼肌 眩暈外耳道或中耳腔新生物：肉芽，質(zhì)脆，易出血Company Logo中耳癌-診斷影像學(xué)檢查 High-resolution CT scans Magnetic resonance imaging (MRI) 病理學(xué)檢查 Company Logo中耳癌-診斷Company Logo中耳癌-診斷Company Logo中耳癌-治療手術(shù)治療 乳突切除術(shù) 顳骨次全切除術(shù) 顳骨全切除術(shù) 放射治療 Company Logo聽(tīng)神經(jīng)瘤Acoustic Neuromas (AN)Company Logo 耳神經(jīng)外科

10、最常見(jiàn)的良性腫瘤，起源于第顱神經(jīng)，又稱前庭神經(jīng)鞘膜瘤Vestibular schwannoma (VS) 約占顱內(nèi)腫瘤的10%，占小腦腦橋角腫瘤的78%起源于神經(jīng)鞘膜的雪旺細(xì)胞平均增長(zhǎng)速度1.6-6.1mm/每年發(fā)病率有增高趨勢(shì)聽(tīng)神經(jīng)瘤-概述Company Logo單側(cè)感音神經(jīng)性聾Unilateral hearing loss (95% ) gradually sudden 26% 耳鳴Tinnituscochlear nerve symptomsvestibular nerve symptoms眩暈Vertigo頭暈Dizziness 平衡障礙Unsteadinessthe symptoms

11、 and clinical findingsHeadacheAtaxia共濟(jì)失調(diào)facial numbnessdiplopia 復(fù)視Dysphagia吞咽困難 聽(tīng)神經(jīng)瘤-臨床表現(xiàn)Company Logo聽(tīng)神經(jīng)瘤-診斷 聽(tīng)力學(xué)檢查 純音測(cè)聽(tīng)：感音神經(jīng)性聽(tīng)力下降，高頻明顯 言語(yǔ)測(cè)試：言語(yǔ)分辨率下降 聽(tīng)性腦干反應(yīng)（ABR）：波潛伏期延長(zhǎng)，雙耳 差0.4ms ABR是目前檢測(cè)聽(tīng)神經(jīng)瘤最敏感的聽(tīng)力學(xué)方法，敏感性為85%-90% 前庭功能檢查 異常眼震電圖，患側(cè)冷熱試驗(yàn)變?nèi)?自發(fā)性眼震Company Logo聽(tīng)神經(jīng)瘤-診斷 影像學(xué)檢查 CT顯示內(nèi)聽(tīng)道骨性結(jié)構(gòu)是否增寬和侵蝕 小于5mm的腫瘤顯示不佳 MRI目前診斷聽(tīng)神經(jīng)瘤最敏感、最有效的方法 增強(qiáng)可發(fā)現(xiàn)小至1mm的腫瘤Company Logo聽(tīng)神經(jīng)瘤-診斷Company Logo聽(tīng)神經(jīng)瘤-診斷MRIT1W略低信號(hào)MRIT2W高信號(hào)Company Logo聽(tīng)神經(jīng)瘤-治療手術(shù)切除 Surgery-目前公認(rèn)的首選治療方法 經(jīng)迷路 translabyrinthine (TL) 經(jīng)乙狀竇后 retrosigmoid (RS) 經(jīng)顱中窩 middle