全视下逆行法面神经解剖术切除腮腺混合瘤  

Mixed tumor of parotid gland excised by retrograde dissection of facial nerve under full exposure

作　　者：王志军[1] 王娜[1] 陈灿[1] 田红军[1] 刘志刚[1] 张晨[1] 高景恒[2] 

机构地区：[1]大连大学附属新华医院整形外科,辽宁大连116021 [2]辽宁省人民医院

出　　处：《中国美容整形外科杂志》2010年第8期464-467,共4页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的 探索快速安全的面神经解剖术切除腮腺混合瘤的方法.方法 直视下解剖分离面神经分支,在一个安全平面分离,一次性完全显露面神经的颧支、颊支、下颌缘支;或一次性完全显露面神经的颞支.然后由外周向中心解剖面神经,切除腮腺混合瘤和浅叶腮腺组织.切除肿瘤后应用SMAS瓣法修复面部形态.结果 本组患者28例,均Ⅰ期愈合.手术时间50～90 min,平均65 min;出血量平均70 ml.1例并发面神经颧支损伤（3.6%）,于术后3个月恢复;2例并发涎腺瘘（7.1%）,分别于术后1、2周时治愈.25例获随访3～12个月,无复发.结论 在安全平面内分离一次性显露各面神经分支的全视下逆行法面神经解剖术,较传统方法更快速、安全地解剖面神经,切除腮腺肿瘤和浅叶腮腺组织,提高手术效率,降低并发面神经损伤的风险.Objective To explore a quick and safe facial nerve dissection in the resection of mixed tumor of parotid gland. Methods Under orthophoria, facial nerves were separated at a safe layer to expose the zygomarie branches, buccal branches, marginal mandibular branches entirely; or the temporal branches exposed directly. Then, the facial nerves were dissected by advancing side by side from the periphery to the center and the mixed tumor of parotid gland and the superficial lobe tissue were excised. The face after tumor excision was repaired with SMAS flap method. Results Twenty-eight cases who performed the resection of mixed tumor of parotid gland and facial nerve dissection healed primarily except for 1 case with zygomatic branch injury （3.6%） which recovered at 3 months postoperatively and 2 cases with salivary fistula （7.1%） which cured at 1 and 2 weeks respectively after operation. The operation duration was from 50 to 90 minutes, average time was 65 minutes, the average hemorrhage volume was 70 ml. After 3 - 12 months following-up, for 25/28 cases, all 25 cases healed without recurrence. Conclusion The retrograde dissection of facial nerve under full exposure could expose all of the facial nerve branches in a safe layer. Compared with the traditional technique, this technique dissects the facial nerve, resects the parotid mixed tumor and superficial lobe tissue more quickly and safely. The effect of facial form reconstitution by the SMAS flap on the operation is satisfactory.

关 键 词：面神经解剖术 逆行法 腮腺混合瘤 

分 类 号：R73[医药卫生—肿瘤] R622[医药卫生—临床医学]