腮腺多形性腺瘤安全手术切缘的界定  

Evidence for determining the safe surgical margin for pleomorphic adenoma of parotid gland

作　　者：徐义全[1] 李超[2] 樊晋川[2] 张兵[2] 陈建超[2] 王朝晖[2] 王影[1] 覃胜[3] 青晓艳[1] 万俊峰[3] 李伦[1] 汤梅[3] 杨红[3] 梁博[4] 

机构地区：[1]广西医科大学研究生学院,南宁530021 [2]四川省肿瘤医院四川省肿瘤研究所头颈外科 [3]四川省肿瘤医院四川省肿瘤研究所病理科 [4]泸州医学院

出　　处：《中华耳鼻咽喉头颈外科杂志》2012年第2期137-141,共5页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：四川省卫生厅科研资助项目（090538）

摘　　要：目的 比较腮腺区域切除术和腮腺浅叶切除＋面神经解剖术治疗腮腺多形性腺瘤的疗效、术后并发症及组织病理学特性,为界定区域性切除安全手术切缘提供依据.方法 回顾性分析109例患者临床资料,其中行腮腺浅叶切除＋面神经解剖术（传统手术）60例,行腮腺区域切除术（保留功能）49例,比较两组患者术后肿瘤复发、并发症、肿瘤组织标本病理学特性发生率,浸润深度及其相关因素.结果 两组患者的肿瘤复发、面神经麻痹、涎腺瘘发生率差异均无统计学意义.传统手术组的Frey综合征、耳廓区麻木感、面部外形明显不对称的发生率分别为30.0％、61.7％、38.3％,而保留功能组分别为6.1％、30.6％、8.2％,差异均有统计学意义（P值均＜0.05）.4种病理学特征在3种组织学类型（细胞型、经典型和黏液型）中的分布为：包膜不完整33例,在黏液型中分布最多（12例）；包膜浸润29例,在细胞型和经典型中最多（15例和13例）；伪足现象25例,在黏液型中最易发生（10例）；卫星灶13例,发生率与在各种肿瘤组织学类型中差异无统计学意义.26例肿瘤最大径小于2 cm者最大浸润深度为3.127 mm,传统手术组与保留功能组比较差异无统计学意义（Z=-1.093,P=0.057）；肿瘤最大径2～4 cm患者共67例,最大浸润深度7.908mm,两组差异无统计学意义（Z=-0.214,P=0.831）；肿瘤最大径＞4 cm的16例,最大浸润深度为8.476 mm.结论 与传统腮腺术式相比,功能性区域切除术不增加复发率,且可减少术后并发症的发生；术后标本的浸润深度与肿瘤大小有关；区域切除术的安全手术切缘应根据肿瘤部位、大小决定.小于4 cm的肿瘤,其安全切缘为1 cm,大于4 cm的肿瘤行浅叶切除术.Objective To compare the treatment outcomes,complications and histopathologic features between conventional parotidectomy and functional regional parotidectomy in the treatment for pleomorphic adenoma of parotid gland and to provide clinical,and pathological evidence for determining the safe surgical margin.Methods Of 109 patients,60 patients received conventional parotidectomy and 49 patients received functional regional parotidectomy.The rates of tumor recurrence and complications were compared between the groups of patients.Results There was no significant difference in the incidence of tumor recurrence,the facial paralysis and sialosyrinx between two groups.The rates of Frey＇s syndrome,numbness of auricular region,and facial asymmetry were 30.0%,61.7%,and 38.3% in the patients with conventional parotidectomy respectively,while the rates were 6.1%,30.6%,and 8.2% in the patients with functional regional parotidectomy,with significant statastically difference,respectively （P 〈 0.05 ）.Of 109 patients,33 with incomplete capsule,29 with capsule penetration,25 with pseudopodia,and 13 with satellite nodules.There was no significant difference in the depth of tumor infiltration between two groups of patients.For the tumor smaller than 2 cm,the depth of infiltration in conventional group was from 0.061 to 1.122 mm,functional group was from 0.442 to 3.127 mm （Z =- 1.093,P =0.057） ; for the tumors between 2 - 4 cm,the depth in conventional group was from 0.081 to 7.908 mm,functional group was from 0.082 to 6.632 mm （ Z =-0.214,P =0.831 ） ;for the tumor larger than 4 cm,the depth of infiltration was from 0.340 to 8.476 mm.Conclusions Compared with conventional parotidectomy,functional regional parotidectomy has good outcomes and less complications.The surgical margins of pleomorphic adenomas of the parotid gland should be determined by the size of tumor.The 1 cm-surgical margins are safe for the tumors less than 4 cm,and the tumors more than 4 cm should be treated with superficial parotidectomy.

关 键 词：腮腺肿瘤 腺瘤 多形性 手术后并发症 病理学 临床 

分 类 号：R739.8[医药卫生—肿瘤]