타액선 종양에 관한 임상적 고찰

Abstract

[한글]

타액선종양은 두경부종양중에서 병리조직학적 양상이 가장 다양한 종양으로 대부분이 분비선 기원이나 때로는 간질세포, 혈관조직, 임파망상조직에서도 발생한다. 타액선은 위치에 따라 크게 이하선, 악하선, 설하선, 소타액선으로 구분되고, 소타액선은 구순, 구강

점막,구개, 비점막, 각종인두, 상부식도등 상부호흡소화관의 어느 부위에든지 산재하고 있다. 타핵선종양은 이들 각종 타액선에서 발생할 수 있으며 설하선을 제외하고는 대체로 타액선의 크기에 비례해서 발생하며, 전체적으로는 양성종양이 많으나 크기가 작은 타액선일수록 악성의 빈도가 높은 경향이 있다. 각 종양은 양성이든 악성이든 그 생물학적 특성이 서로 다르기 때문에 근치적 치료를 시행하려면 이에 대한 올바른 이해와 정확한 해부학적 지식과 진단기술 및 고도의 수술수기를 필요로 한다. 최근에는 타액선에 대한 해부학적 지식, 컴퓨터 단층촬영등의 임상진단, 수술시 동결절편등의 병리조직하적 진단, 수술수기의 발달등으로 타액선종양의 치료에 많은 발전을 가져온 것은 사실이지만 아직도 종양의 종류에 따라 높은 국소재발율과 낮은 생존율이 문제로 되어있다. 저자는 1965년

1월 1일부터 1982년 6월 30일까지 연세의료원에서 경험한 타액선종양 157예를 양성과 악성으로 구분하여 양군사이의 임상상의 차이점, 치료방법 및 치료결과에 대하여 관찰분석하여 다음과 같은 결과를 얻었다.

1. 종양이 발생한 위치는 이하선 118예(75%), 악하선 33예(21%), 설하선 및 소타액선 6예(4%)순이었고, 각 타액선에 발생한 종양의 악성빈도는 이하선이 36%, 악하선이 24%,설하선 및 소타액선이 33%이었다.

2. 약성종양 105예의 평균연령은 33세이었고 악성종양 52예의 평균연령은 51세이었으며, 남녀비는 1:1.45로 여자에서 다소 높은 빈도들 보였다.

3. 성별, 병력기간별, 종양의 크기에 따른 악성빈도는 남자에서 약간 높은 빈도를 보인 것 외에는 특별한 상관관계가 없었다.

4. 양성종양은 pleomorphic adenoma가 91%로 대부분이었고, 악성종양은 mucoepldermoid carcinoma, acinic call carcinoma, adenocarcinoma가 58%로 주종을 이루고 있었다.

5. 전체 악성종양의 평균 임파절전이율은 23%이었고, 조직하적 유형에 따라서는 high grade malignancy일수록 높은 전이율을 보였다.

6. 수술후 합병율은 양성은 11%,악성은 29%이었는데, 주합병은 안면신경마비, Frey씨 증후군, 타액루등이었다.

7. 치료후 재발율은 양성은 15%, 악성은 29%로 양성과 악성 다같이 소극적인 수술을 시행했던 경우에서 높았다.

8. 전체 악성 종양의 5년 생존율은 66%이었으며, 그중 low grade malignancy는 74%이었고, high grade malignancy는 48%이었다.

이상의 결과로 타액선종양의 치료는 어디까지나 외과적 완전절제가 주 치료방법이며, 악성종양의 경우에는 수술시 동결절편검사의 활용으로 각 종양의 조직학적 특성과 암의 진행정도에 따라 수술범위를 결정하고 또한 수술후 방사선치료를 병용함으로써 보다 양호한 치료성적을 얻을 수 있을 것으로 사료된다.

A clinical analysis of salivary gland tumors

Won Kon Han, M.D.

Department of Medical Science, The Graduate School, Yonsei University

(Directed by Prof. Choon Kyu Kim, M.D.)

Author reviewed 157 patients of salivary gland tumors at Yonsei Medical Center

during the period from January 1, 1965 to June 30, 1982. They were categorized into

benign and malignant tuners and their clinical differences, methods of treatment,

and results of the treatment were analyzed.

The following results were obtained:

1. The originating place of the tumors in order were parotid gland with 118

patients (75%), submaxillary gland with 33 patients (21%) and 6 patients (4%) from

sublingual gland and minor salivary gland. The incidence of malignant tumors for

each gland were parotid gland 36%, submaxillary gland 24% and sublingual gland and

minor salivary gland 33%.

2. The average age for the 105 patients with benign tumor were 33 and for 52

patients with malignant tumor were 51 years of age. The occurrence of the tumor

were highter in female than in male, the ratio was 1.45:1.

3. Aside from slight higher incidence in male of malignant tumors, there was no

differences in duration or size of the tumor.

4. Pleomorphic adenoma of benign tumors were 91% and mucoepidermoid carcinoma

acinic cell carcinoma and adenocarcinoma of malignant tumors were 58%.

5. The overall average of lymph node metastasis rate for the malignant tumors

were 23% and histologically, the higher the grade of malignancy, the higher the

metastasis rate.

6. Postoperative complications for benign tumors were l1% and 29% for the

malignant tumors, and main complications were facial nerve palsy, Frey syndrome and

salivary fistula.

7. The recurrence rate after treatment was 15% for benign tumors and 29% for

malignant tumors and when palliative surgery were performed on both benign and

malignant timors, the recurrence rate was higher.

8. The overall 5 year survival rate for the malignant tumors were 66%. However,

for the low glade malignancy were 74% and for the high glade malignancy were 48%.

With above results, the main method of treatment for the salivary gland tumors

are complete resection.

In case of malignant tumors, with histologic features from frozen biopsy during

the surgery and with degree of metastasis, the operative field is determined. Also,

with combined treatment of postoperative radiotherapy, we believe the results of

treatment will be even more satisfactory.

[영문]

Author reviewed 157 patients of salivary gland tumors at Yonsei Medical Center during the period from January 1, 1965 to June 30, 1982. They were categorized into benign and malignant tuners and their clinical differences, methods of treatment, and results of the treatment were analyzed.

The following results were obtained:

1. The originating place of the tumors in order were parotid gland with 118 patients (75%), submaxillary gland with 33 patients (21%) and 6 patients (4%) from sublingual gland and minor salivary gland. The incidence of malignant tumors for

each gland were parotid gland 36%, submaxillary gland 24% and sublingual gland and minor salivary gland 33%.

2. The average age for the 105 patients with benign tumor were 33 and for 52 patients with malignant tumor were 51 years of age. The occurrence of the tumor were highter in female than in male, the ratio was 1.45:1.

3. Aside from slight higher incidence in male of malignant tumors, there was no differences in duration or size of the tumor.

4. Pleomorphic adenoma of benign tumors were 91% and mucoepidermoid carcinoma acinic cell carcinoma and adenocarcinoma of malignant tumors were 58%.

5. The overall average of lymph node metastasis rate for the malignant tumors were 23% and histologically, the higher the grade of malignancy, the higher the metastasis rate.

6. Postoperative complications for benign tumors were l1% and 29% for the malignant tumors, and main complications were facial nerve palsy, Frey syndrome and salivary fistula.

7. The recurrence rate after treatment was 15% for benign tumors and 29% for malignant tumors and when palliative surgery were performed on both benign and malignant timors, the recurrence rate was higher.

8. The overall 5 year survival rate for the malignant tumors were 66%. However, for the low glade malignancy were 74% and for the high glade malignancy were 48%.

With above results, the main method of treatment for the salivary gland tumors are complete resection.

In case of malignant tumors, with histologic features from frozen biopsy during the surgery and with degree of metastasis, the operative field is determined. Also, with combined treatment of postoperative radiotherapy, we believe the results of treatment will be even more satisfactory.