摘要： 目的·初步观察中国人群散发性听神经瘤的中短期自然生长速度及其与临床特征的关系。方法·回顾性分析2016年3月至2019年11月在上海交通大学医学院附属第九人民医院耳鼻咽喉头颈外科就诊及随访复诊的散发性听神经瘤患者；要求纳入研究的患者至少有2次增强磁共振的数字资料且首末2次间隔时间>60 d。收集患者的增强磁共振DICOM资料、听力学资料（纯音听阈及言语识别率）、临床表现（听力下降、耳鸣、眩晕、面部疼痛或麻木）等。通过Horos
TM软件载入影像学数据，进行肿瘤大小的测量，并计算肿瘤生长速度。随后对肿瘤的生长速度与临床表现进行关联性分析。结果·共有56例患者纳入研究，男、女各28例，平均年龄（48.6±12.0）岁，初诊时肿瘤最大径为（15.9±9.6）mm，2次磁共振检查的间隔时间为（266.3±313.5）d，总体肿瘤生长速度为（4.4±4.7）mm/a；其中8例囊性变肿瘤的生长速度显著快于余48例非囊性变［（9.4±3.8）mm/a
vs （3.6±4.4）mm/a，
P=0.003］。在非囊性变肿瘤患者中，初诊时22例内听道内型和小型（≤10 mm）肿瘤相对其他肿瘤的生长速度较慢［（2.1±3.6）mm/a
vs （4.8±4.7）mm/a，
P=0.031］；60岁及以上患者的肿瘤生长速度显著慢于60岁以下的患者［（1.7±3.1）mm/a
vs （4.2±4.6）mm/a，
P=0.040］。主动采用随访策略者中，58.8%患者肿瘤稳定，81.8%有可测听力者未出现听力分级下降。有无突聋、耳鸣或眩晕史的患者间，初诊时不同听力分级患者间，不同性别、患侧的患者间的肿瘤生长速度差异均无统计学意义（均
P>0.05）。结论·囊性变听神经瘤生长迅速，需积极治疗；内听道内型和小型（≤10 mm）非囊性变患者，以及60岁及以上患者肿瘤生长较为缓慢；符合影像学观察随访策略的患者在1年内可基本维持原有听力水平。
关键词: 散发性听神经瘤, 肿瘤生长速度, 临床表现, 听力, 影像学随访 Abstract: Objective·To preliminarily observe the natural history of the sporadic acoustic neuroma and its relationship with clinical manifestations in Chinese population.
Methods·From March 2016 to November 2019, the patients with sporadic acoustic neuroma who had visit and follow-up in the Department of Otolaryngology-Head and Neck Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine were analyzed retrospectively. The patients included in the study were required to have at least two digital data of enhanced MRI, and the interval between the first and the last time was more than 60 d. Their radiological DICOM data (enhanced MRI), audiological reports (pure tone average threshold and speech discrimination score), and clinical manifestations (hearing loss, tinnitus, vertigo, and facial pain or numbness) were collected. Image data were loaded by HorosTM software to measure tumor size and calculate tumor growth rate. Then the relationship between tumor growth rate and clinical manifestations was analyzed.
Results·A total of 56 patients were included, 28 males and 28 females, with the average age of (48.6±12.0) years old. Their initial tumor size was (15.9±9.6) mm in the maximum diameter, and the mean interval between the two times of MRI was (266.3±313.5) d. The average growth rate was (4.4±4.7) mm/a. Eight cystic tumors grew more rapidly than non-cystic ones [(9.4±3.8) mm/a vs (3.6±4.4) mm/a, P=0.003). Among the 48 non-cystic acoustic neuromas, 22 internal auditory canal type and small (≤10 mm) tumors grew more slowly than other tumors [(2.1±3.6) mm/a vs (4.8±4.7) mm/a, P=0.031]; the tumors grew more slowly in the patients with the ages of 60 years or above than those in the patients younger than 60 years old [(1.7±3.1) mm/a vs (4.2±4.6) mm/a, P=0.040]. 58.8% of the patients undergoing active “wait and scan” strategy had stable tumors, and 81.8% patients with measurable hearing did not show hearing deterioration during their follow-up. Other factors like sudden deafness, tinnitus, vertigo, initial hearing level, sex, and tumor side had no correlations with tumor growth rate (all P>0.05).
Conclusion·Cystic sporadic acoustic neuroma is confirmed as a rapid growth tumor, which needs active treatment. The tumors grow slowly in the non-cystic acoustic neuromas which are internal auditory canal type, not bigger than 10 mm or in the patients aged 60 years and above. The cases that are suitable for “wait and scan” policy can basically maintain their original hearing level during one year.
Key words: sporadic acoustic neuroma, tumor growth rate, clinical manifestation, hearing, radiologic follow-up PDF全文下载地址:
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