《耳鼻喉科室》课件耳鼻喉 耳部肿瘤

1、耳部肿瘤Tumors of Ear 郑州大学第一附属医院耳科 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外耳良性肿瘤 外耳道乳头状瘤 papillo

2、ma of extenal canal 男性好发，反复挖耳所致 出血、阻塞感、听力减退 耳道多发或单发桑葚状肿物，质地较硬 手术切除：肿瘤边缘正常皮肤1mm以上Company Logo外耳良性肿瘤 耳廓和外耳道血管瘤 hemangioma 主要位于耳廓 毛细血管瘤 capillary hemangioma 海绵状血管瘤 cavernous hemangioma 蔓状血管瘤arterial racemosum hemangioma 非手术治疗：冷冻、激光、放射、局部注射硬化剂 手术治疗Company Logo外耳良性肿瘤 耵聍腺瘤 ceruminoma 好发于外耳道软骨部耵聍腺分布区 发病缓慢，

3、肿瘤较大可致听力障碍 外耳道后下局限性隆起，黄豆大小，表面皮肤正常 手术治疗：易恶变，切除范围包括肿瘤边缘至少0.5cmCompany Logo外耳良性肿瘤 外耳道骨瘤 exostosis 早期无症状，肿瘤体积增大可出现耳闷、听力下降 外耳道骨部球星隆起，皮肤正常，质硬 CT显示外耳道骨性段骨样密度增生 手术治疗Company Logo外耳恶性肿瘤 腺样囊性癌 adenoid cystic carcinoma，ACC 低度恶性肿瘤，生长缓慢 症状不典型，持续多年，易复发 耳痛、耳道肿块，听力下降、耳鸣、流脓、耳痒 耳道皮下隆起，界限不清，质硬，触痛，肉芽，溃疡 手术治疗：彻底切除为主，辅助放疗

4、Company Logo外耳恶性肿瘤 恶性黑色素瘤adenoid cystic carcinoma 低度恶性肿瘤，生长缓慢 症状不典型，持续多年，易复发 耳痛、耳道肿块，听力下降、耳鸣、流脓、耳痒 耳道皮下隆起，界限不清，质硬，触痛，肉芽，溃疡 手术治疗：彻底切除为主，辅助放疗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鳞状细胞癌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基底细胞癌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%，占耳部肿瘤的1.5% 以鳞状上皮癌最多见 40-60岁为好发年龄 性别与发病率无显著差别病因80%有长期慢性化脓性中耳炎病史电离辐射、理化刺激、乳头状瘤恶变Company LogoPrimary squamous carcinoma ofmiddle ear Company Logo中耳

9、癌-临床表现 出血：耳道无痛性出血 耳痛 听力障碍 同侧周围性面瘫 张口困难：侵犯颞颌关节或翼肌 眩晕外耳道或中耳腔新生物：肉芽，质脆，易出血Company Logo中耳癌-诊断影像学检查 High-resolution CT scans Magnetic resonance imaging (MRI) 病理学检查 Company Logo中耳癌-诊断Company Logo中耳癌-诊断Company Logo中耳癌-治疗手术治疗 乳突切除术 颞骨次全切除术 颞骨全切除术 放射治疗 Company Logo听神经瘤Acoustic Neuromas (AN)Company Logo 耳神经外科

10、最常见的良性肿瘤，起源于第颅神经，又称前庭神经鞘膜瘤Vestibular schwannoma (VS) 约占颅内肿瘤的10%，占小脑脑桥角肿瘤的78%起源于神经鞘膜的雪旺细胞平均增长速度1.6-6.1mm/每年发病率有增高趋势听神经瘤-概述Company Logo单侧感音神经性聋Unilateral hearing loss (95% ) gradually sudden 26% 耳鸣Tinnituscochlear nerve symptomsvestibular nerve symptoms眩晕Vertigo头晕Dizziness 平衡障碍Unsteadinessthe symptoms

11、 and clinical findingsHeadacheAtaxia共济失调facial numbnessdiplopia 复视Dysphagia吞咽困难 听神经瘤-临床表现Company Logo听神经瘤-诊断 听力学检查 纯音测听：感音神经性听力下降，高频明显 言语测试：言语分辨率下降 听性脑干反应（ABR）：波潜伏期延长，双耳 差0.4ms ABR是目前检测听神经瘤最敏感的听力学方法，敏感性为85%-90% 前庭功能检查 异常眼震电图，患侧冷热试验变弱 自发性眼震Company Logo听神经瘤-诊断 影像学检查 CT显示内听道骨性结构是否增宽和侵蚀 小于5mm的肿瘤显示不佳 MRI目前诊断听神经瘤最敏感、最有效的方法 增强可发现小至1mm的肿瘤Company Logo听神经瘤-诊断Company Logo听神经瘤-诊断MRIT1W略低信号MRIT2W高信号Company Logo听神经瘤-治疗手术切除 Surgery-目前公认的首选治疗方法 经迷路 translabyrinthine (TL) 经乙状窦后 retrosigmoid (RS) 经颅中窝 middle