腮腺肿瘤的个性化治疗『2012-7-27修改稿』.doc

腮腺肿瘤的个性化治疗 北京解放军306医院耳鼻咽喉头颈外科：王佩林 李保卫 韩浩伦 王鸿南 王刚 【摘要】 目的　探讨多种类型腮腺肿瘤个性化治疗方式选择方案和规律。以期达到功能和精确外科之目的。方法 回顾性的对115例腮腺肿瘤治疗方式进行分析，把腮腺肿块分为腮腺上部肿物和下部肿物，针对不同的部位肿瘤采取相应的手术方式，恶性肿瘤术后配合放射治疗。术后随访0.5～10年。评测治疗效果和术后并发症。结果 腮腺良性肿瘤95例，术后暂时性面神经麻痹17例，1～3个月后恢复；Frey氏综合征3例；未出现复发、涎瘘和明显面部凹陷。恶性肿瘤20例，采用了腮腺全切除术或加舌骨上颈淋巴结清扫术，术后出现暂时性面神经麻痹15例，永久性面瘫5例，其中2例术前既有。18例术后放射治疗，术后未出现复发，2例未做放疗，术后2年复发。1例因心血管疾病死亡。结论 腮腺良性肿瘤个性化治疗是理想的选择，恶性肿瘤在腮腺全切的基础上根据美国国家综合癌症网（NCCN）的指导意见选择性的舌骨上颈淋巴结清扫术，术后需要放射治疗。 [关键词] 腮腺肿瘤；个性化治疗；术后并发症 Considerations for personalized surgery in patients with parotid tumors Wang Pei-lin,Li Bao-wei,Han Hao-lun,Wang Gang, Wang Hong-nan.Dept. of ENT with Head and Neck Surgery. 306 Hospital of PLA. Beijng 100101.China 【Abstract】 Objective To explore a variety of types of parotid gland tumors personalized treatment optionsto achieve the purpose of the functional and precise surgery. Methods A retrospective study of 115 cases of parotid gland tumors was analyzed. The tumors in the upper and lower part of the parotid gland were taken the appropriate surgical approach respectively, malignant tumor with radiation therapy after surgery. Patients had been followed up for 0.5-10 years, Evaluation of treatment and postoperative complications. Result 17 postoperative temporary facial paralyses after 95 cases of benign tumor surgeries, recovery after 1 to 3 months; 3 Frey,s syndromes; no recurrence, salivary fistula, and obvious facial depression. 20 cases of malignant tumors used parotid total excision or suprahyoid neck dissection, 15 postoperative temporary facial paralyses and 5 permanent facial paralyses, including two cases of preoperative paralyses. 18 cases them got postoperative radiation therapy after surgery and does not appear to recur, 2 cases without radiotherapy, recurrence after two years. Conclusion benign tumor personalized treatment is an ideal choice. The malignant tumors of parotid gland got a full parotid cut, optional addition of the suprahyoid neck dissection and postoperative radiotherapy. [