Publikationsserver der Universitätsbibliothek Marburg
Titel:Lipomatöse Neoplasien im Kopf-Hals-Bereich
Autor:May, Frederik
Weitere Beteiligte: Teymoortash, Afshin (Prof. Dr.)
Veröffentlicht:2017
URI:https://archiv.ub.uni-marburg.de/diss/z2018/0017
DOI: https://doi.org/10.17192/z2018.0017
URN: urn:nbn:de:hebis:04-z2018-00172
DDC: Medizin
Publikationsdatum:2018-01-24
Lizenz:https://creativecommons.org/licenses/by-nc-sa/4.0

Dokument

Schlagwörter:
Lipom Kopf Hals benign Neoplasie, lipoma head neck lipomatous neoplasm

Zusammenfassung:
Lipogen differenzierte Tumore stellen mit einem Anteil bis zu 50% die größte Gruppe der benignen mesenchymalen Weichgewebstumore dar. Hiervon sind 13-17% im Kopf-Hals-Bereich lokalisiert. Ziel der vorliegenden Dissertation ist es, einen detaillierten Überblick über lipomatöse Neoplasien im Allgemeinen sowie speziell über Lipome des Kopf-Hals-Bereiches zu geben. Hierzu wurden die klinischen Daten von 77 Patienten der Hals-, Nasen- und Ohrenklinik der Universität Marburg in einem Zeitraum von zehn Jahren retrospektiv analysiert. Besonders eingegangen wurde auf die genaue Lokalisation und die hierdurch bedingten Besonderheiten der klinischen Symptomatik sowie auf die unterschiedlichen diagnostischen Verfahren und Therapiemodalitäten. Des Weiteren wurden die kurz- und langfristigen Therapieresultate erfasst. Zudem wurde zu der in der Literatur kontrovers diskutierten Assoziation zwischen Lipomen, BMI und bestehenden Begleiterkrankungen Stellung genommen. Die vorliegenden Ergebnisse wurden unter Berücksichtigung der Literatur vergleichend analysiert. Der Anteil der männlichen Patienten war mit 75,3% (n=58) deutlich höher als der weibliche Anteil von 24,7% (n=19). Dies entspricht einem Verhältnis von 3:1. Ein starker Anstieg der Prävalenz war für beide Geschlechter in der vierten bis zu der sechsten Lebensdekade festzustellen. Diese Ergebnisse decken sich mit den Werten anderer großer Studien. Hinsichtlich der Lokalisation traten sie am häufigsten im Bereich des Halses (50%), im nuchalen Bereich (16,3%), aurikulär und periaurikulär (8,8%) sowie in der Glandula parotis (6,3%) auf. Bei einer genaueren Aufteilung der zervikal gelegenen Lipome konnte ein Maximum an Neubildungen in den Lymphknotenleveln I und II diagnostiziert werden. Im Allgemeinen traten 71,3% der Neoplasien in der oberflächlichen Subkutis auf und 28,7% waren im tiefen Weichgewebe lokalisiert. Die Volumina reichten von weniger als 5 cm³ messenden Tumoren bis hin zu einer Größe von fast 500 cm³. Der Grund für die Vorstellung in der Klinik war in 99% der Fälle eine augenscheinliche Schwellung. Schmerzen wurden von 14% der Patienten mit jeweils großflächigen oder nervnah gelegenen Neoplasien angegeben. Prälaryngeal oder lateral zervikal gelegene Tumore führten in 12% der Fälle zu einem Globus- oder Druckgefühl. In den tiefen Halsweichteilen gelegene Lipome führten bei 4% der der Patienten zu Beschwerden in Form einer Dsyphagie und zu 1,3% zu einer Dysphonie. Die Auswertungen bezüglich des BMI ergaben, dass insgesamt 72,7% der Patienten übergewichtig waren. Hiervon hatten 29,9% eine behandlungsbedürftige Fettleibigkeit. Ein Auftreten von lipomatösen Neoplasien bei untergewichtigen Patienten konnte hingegen nicht festgestellt werden. Die hier ermittelten Werte bekräftigen eine von vielen Autoren klinisch beobachtete Assoziation von Übergewicht mit lipogen differenzierten Tumoren. Ein Zusammenhang mit bestimmten Begleiterkrankungen die in der Literatur mit lipomatösen Neoplasien vergesellschaftet sein können wurde nicht deutlich. Als diskutierte Begleiterkrankungen gelten die koronare Herzkrankheit, Diabetes mellitus, Hyperurikämie, Hyperlipidämie, Alkoholismus und Neuropathie. Stoffwechselerkrankungen die für gewöhnlich mit Obesitas assoziiert sein können traten in Form von Diabetes mellitus mit 6,5% und der koronaren Herzkrankheit mit 7,8% am häufigsten auf. Das initiale diagnostische Verfahren zur Untersuchung lipomatöser Neoplasien stellte zu 93,8% die Ultraschallsonographie dar. Zur weiterführenden Bildgebung wurden zu 47,5% die Magnetresonanztomographie und zu 5% die Computertomographie angewandt und zeigten sich als akkurate präoperative Methoden. Die Feinnadelaspirationsbiopsie erfolgte in 52,5% der Fälle und zeigte eine Sensitivität von 62%. Die operative Entfernung ist die Standardtherapie von lipomatösen Neoplasien und wurde zu 84,4% in Form einer einfachen Exstirpation durchgeführt. Lipome im Bereich der Glandula parotis wurden mittels lateraler Parotidektomie (9,1%) entfernt. Des Weiteren wurden zwei extendierte Resektionen im Sinne einer selektiven Neck dissection durchgeführt. Bei einem Patienten mit tiefgelegenem Lipom in der Region des Aryknorpels konnte der Tumor mikrolaryngoskopisch exstirpiert werden. Ein Angiolipom, welches den Musculus temporalis infiltrierte, wurde nach vorangegangener Embolisation reseziert und durch einen Sternocleidomastoideus-Lappen gedeckt. Die chirurgische Entfernung der Lipome fand zu 88,5% in Intubationsnarkose und zu 11,5% in Lokalanästhesie statt. Intraoperatives Neuromonitoring kam in 16,7% der Fälle zur Anwendung. Dies betraf alle sieben durchgeführten lateralen Parotidektomien, drei Lipomexzisionen im Bereich des Spatium buccale sowie die Exzision zweier periaurikulären und eines submandibulär gelegenem Lipoms. Die mittlere Operationsdauer aller Exzisionen unter Intubationtionsnarkose lag bei 112,61 ± 58,5 Minuten. Intraoperative Komplikationen in Form einer Nervenschädigung mit passagerer Mundastschwäche gehörten zu den größten Gefahren im Kopf-Hals-Bereich und traten bei vier Patienten (5,1%) auf. Postoperativ zeigte sich bei vier Patienten eine Wunddehiszenz, welche konservativ therapiert werden konnte. Im postoperativen Langzeitverlauf konnten sechs geringfügige passagere Parästhesien und eine Speichelgangfistel nach erfolgter Exstirpation festgestellt werden. Die histologischen Varianten ergaben in 87,5% der Fälle normale Lipome, zu 5% Fibrolipome, Spindelzell/Pleomorphe Lipome zu 3,7%, intermuskuläre Lipome zu 2,5% und zu 1,3% Angiolipome.

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