沿下颌缘支逆向分离面神经腮腺手术57例临床研究.docVIP

沿下颌缘支逆向分离面神经腮腺手术57例临床研究[摘要] 目的:分析沿下颌缘支逆向分离面神经方法切除腮腺肿瘤的手术效果。方法:统计2003年1月～2008年1月腮腺肿瘤手术57例患者的病例资料,所有患者手术时采用沿下颌缘支逆向分离面神经的方法。结果:全组患者顺利完成手术,术后2例并发涎瘘,3例面神经损伤。结论:沿下颌缘支逆向分离面神经的腮腺手术方法从浅到深分离,操作方便、术野清晰、创伤极小、出血较少、优点明显、效果满意。 [关键词] 腮腺肿瘤;面神经;下颌缘支 [中图分类号] R739.87 [文献标识码]A [文章编号]1674-4721(2010)04(c)-026-02 Clinical reaserch on 57 parotidectomy surgery patients with reverse separate facial nerve along marginal mandibular branch ZHAN Jianwei,SU Guosen (Oncology Surgery Depatrment, the People′s Hospital of Gaozhou,Gaozhou 525200, China) [Abstract] Objective: To study the effect of resection of parotid tumors by retrograded and anatomized on marginal mandibular branch to separate facial nerve. Methods: 57 patients for resection of parotid tumors from January 2003 to January 2008 were analyzed.The way separating facial nerve by retrograded and anatomized on marginal mandibular branch to separate facial nerve was adopted for all patients. Results: All operations were successful. Parotid fistula appeared in 2 patients,facial nerve injury appeared in 3 cases. Conclusion: The way of reversing separate facial nerve along marginal mandibular branch was from shallow soft tissue to deep. It is an effective surgery way for convenient manipulation,clear field of operation, minimal trauma,less bleeding. [Key words] Parotid tumors; Facial nerve; Marginal mandibular branch 腮腺肿瘤是常见的涎腺肿瘤,良性多见,其中恶性肿瘤约占1/3,以手术治疗为首选,且以彻底切除为原则,术后容易发生面瘫、涎瘘、积液、耳颞神经综合征(Frey综合征)[1]及面部畸形不对称[2]等并发症。面神经在腮腺内行走,各分支行程变异较多,容易损伤,因此面神经损伤为最常见的并发症。本科开展的腮腺肿瘤手术,以沿下颌缘支逆向分离面神经的方法游离显露面神经,取得较好效果。现统计分析如下: 1 资料与方法 1.1 一般资料 本组统计2003年1月～2008年1月共57例腮腺肿瘤手术患者,男46例,女11例;年龄22～78岁,中位年龄45.1岁;右侧31例,左侧26例;肿瘤直径1.0～5.1 cm,平均2.6 cm,其中23例4.0 cm;肿瘤发生于浅叶50例,深叶7例,其中腮腺中部42例,腮腺下极9例,耳屏前后6例;病史为半个月至14年,均首次接受治疗;术前行B超或CT检查,实性54例,囊性或囊实性3例。 1.2 手术方法 主要手术方式有腮腺区域切除术(包括腮腺浅叶部分切除术、腮腺浅叶+深叶部分切除术)、腮腺浅叶切除术及腮腺全切除联合或不联合颈淋巴结清扫术。手术过程完整分离肿瘤,不损伤包膜。手术在气管插管全麻下进行,切口设计从耳屏前、后向下前方会合后沿下颌下缘2 cm[3]延长作“Y”形切口,或由耳道颧弓根部开始,沿耳屏前向下至耳垂部,然后弯向乳突,再向下前方沿下颌下缘2 cm延长作“S”切