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Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style,COMPANY,LOGO,Company Logo,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 ear,Benign,neoplastic,lesions of the external ear,1,Malignant,neoplasms,of the external ear,2,Benign,neoplastic,lesions of the middle and inner ear,3,Malignant,neoplasms,of the middle and inner ear,4,Company Logo,Anatomy of Ear,Company Logo,外耳良性肿瘤,外耳道乳头状瘤,papilloma,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，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,0.5cm,Company 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,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,Melanoma,Dark and flat,macule,with variegated colors. Its borders are irregular, with indentations and notches.,Pattern encompasses a radial growth 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,hyperkeratotic,tumor with central ulceration, accompanied with,seroanguinous,exudate,.,middle 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,and 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 normal 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 Logo,Primary,squamous,carcinoma ofmiddle ear,Company Logo,中耳癌,-,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,Tinnitus,cochlear nerve,symptoms,vestibular nerve,symptoms,眩晕,Vertigo,头晕,Dizziness,平衡障碍,Unsteadiness,the symptoms and,c,linical findings,Headache,Ataxia,共济失调,facial numbness,diplopia,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 cranial,fossa,(MCF),保守治疗,Conservative management,观察,wait and scan: watchful waiting,年龄,60,岁,放射治疗,Gamma Knife,Radiosurgery,适用于有外科禁忌，肿瘤,99%,死亡率,95%,，大型听神经瘤,60%,争取保存听力,Company Logo,Thank You !,
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