美容切口在腮腺手术中应用.docVIP

美容切口在腮腺手术中应用[摘要]目的：尝试改良腮腺手术切口，以尽最大可能使切口瘢痕隐蔽。方法：对16例腮腺良性肿瘤患者（其中多形性腺瘤10例、腺淋巴瘤6例）采用耳前切口向下至耳垂后向后延伸至发际并沿发际边缘延伸的改良切口入路行腮腺区肿瘤及浅叶切除、面神经解剖术，术中尽量保留耳大神经，并随访1年观察术后切口隐蔽情况和手术预后。结果：所有患者均达到I期愈合，无涎瘘和感染发生。术中术野暴露清晰，操作方便。术后2例患者出现暂时性面瘫，分别于1和2个月后恢复正常。其余患者未出现面神经损伤症状。16例患者中12例出现术后耳垂麻木，除耳大神经被切断者4例耳垂麻木症状无改善外其余8例均于术后3个月后恢复感觉。另外4例患者因手术切口为颞部和耳前切口未切至耳大神经区术后无耳垂麻木症状。患者对术后切口美观程度满意。术后随访1年无1例患者出现复发。结论：改良切口行腮腺区良性肿瘤及浅叶切除、面神经解剖术，术中术野暴露清晰，操作方便，不易损伤面神经，切口隐蔽，具有临床应用价值。 [关键词]腮腺手术；美容切口；面神经 [中图分类号]R782[文献标识码]A[文章编号]1008-6455（2008）03-03 An aesthetic incision for parotidectomy CHANG Shi-min,LIU Chun-ming,BU Jing-qiu (Department of Oral Maxillofacial Surgery, General Hospital of PLA，Beijing100853,China) Abstract:ObjectiveA modified incision was used in parotidectomy to reduce the visible scar. Methods16 patients with benign parotid gland tumor were included in this study(10 cases with pleomorphic adenoma,6 cases with Warthin tumor). A modified incision was applied to parotidectomy for aesthetic effects and preservation of facial nerve as well as great auricular nerve. One year follow-up was conducted with focus on the cosmetic effect of this incision and the clinical outcome.ResultsThe modified incision healed well in all patients without salivary fistulae. Two patients underwent temporary facial nerve paralysis after the procedure and recovered 1 and 2 months respectively. 12 patients complained of earlobe numb after operation, but recovered 2 months postoperatively except for 4 patients whose great auricular nerves were cut off during operation. All the patients were highly satisfied with this modified incision. No recurrence was founded in all patients.ConclusionThe modifiedincision can be applied to parotidectomy with adequate exposure during operation and ideal postoperative aesthetic effect. Key words: parotidectomy; modified incision; facial nerve 腮腺肿瘤是头颈部常见的疾病，其中95%的肿瘤来源于腺上皮，最常见的为多形性腺瘤。恶性肿瘤约占腮腺肿瘤的20～30%。手术切除是目前腮腺肿瘤最有效的治疗方法。经典手术入路是采用从耳前绕下颌角的“Ｓ”形切口，具有视野暴露充分、不易损伤面神经的优点，被国内外多数术者采用，但是切口