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目的:探讨腮腺淋巴上皮瘤样癌(LELC)的诊断与治疗,进一步提高诊治率。方法:收集我科18例经病理证实的腮腺LELC,回顾性总结和分析本病的临床表现、诊断、治疗及预后。结果:18例腮腺LELC患者中,均为单侧腺体发病;除2例未做EB病毒血清学检查外,其余患者血清学检查结果显示EBV-VCA-IGA阳性率为93%(15/16);EBV-EA-IGA阳性率为75%(12/16);EBV-DNA酶阳性率为63%(10/16)。18例均接受原发灶切除及同侧颈淋巴清扫术,其中腮腺全叶加面神经切除2例,其余均为保留面神经的腮腺浅叶切除术6例;腮腺大部分切除术5例;腮腺全切除术5例;颈上、中部淋巴颈清扫术14例;根治性淋巴清扫术4例,颈淋巴结转移率67%(12/18)。所有患者接受术后放疗50~70 Gy。全组病例1年以上随访,术后2~4年4例局部复发而行再次手术,1、3、5年生存率分别约为94%(17/18)、72%(13/18)、50%(9/18);死亡原因主要为远处转移和肿瘤复发。结论:腮腺LELC的发生与EB病毒感染可能有密切关系,组织病理学表现酷似未分化型鼻咽癌,确诊前需常规行鼻咽活检以排除转移病灶,腮腺LELC颈淋巴结转移率较高,局部侵袭强,治疗上除行局部广泛切除外还应作颈淋巴结清扫,术后辅助放射治疗。
Objective: To investigate the diagnosis and treatment of parotid lymphoepithelioma carcinoma (LELC) and further improve the diagnosis and treatment rate. Methods: Eighteen cases of pathologically confirmed parotid LELC were collected. The clinical manifestations, diagnosis, treatment and prognosis of this disease were retrospectively summarized and analyzed. Results: All the 18 patients with parotid LELC had unilateral glandular disease. Serum test results of other patients showed that the positive rate of EBV-VCA-IGA was 93% (15/16) ). The positive rate of EBV-EA-IGA was 75% (12/16). The positive rate of EBV-DNase was 63% (10/16). 18 cases received resection of the primary tumor and ipsilateral neck lymph node dissection, including parotid total lobe plus facial nerve resection in 2 cases, the rest are facial nerve parotidectomy lobectomy in 6 cases; Parotid most resection in 5 cases; parotid gland There were 5 cases underwent resection, 14 cases underwent lymphatic neck dissection and 4 cases underwent radical lymphadenectomy. The rate of cervical lymph node metastasis was 67% (12/18). All patients received postoperative radiotherapy 50 ~ 70 Gy. All cases were followed up for more than 1 year. Four patients were treated locally for recurrence 2-4 years after operation. Survival rates at 1, 3 and 5 years were 94% (17/18) and 72% (13/18), respectively 50% (9/18). The main causes of death were distant metastasis and tumor recurrence. Conclusion: The occurrence of parotid LELC may be closely related to Epstein-Barr virus infection. Histopathology resembles undifferentiated nasopharyngeal carcinoma. Nasopharyngeal biopsy should be routinely performed before diagnosis to exclude metastatic lesions. Parotid LELC has a higher rate of cervical lymph node metastasis. Local Strong invasion, in addition to the treatment of local extensive excision should be made for cervical lymph node dissection, postoperative adjuvant radiotherapy.