腮腺手术中面神经监护的应用  

Electromyographic monitoring of facial nerve during parotid surgery

作　　者：单小峰[1] 林博[1] 卢旭光[1] 蔡志刚[1] 俞光岩[1] 

机构地区：[1]北京大学口腔医学院.口腔医院口腔颌面外科,北京100081

出　　处：《北京大学学报（医学版）》2014年第1期48-52,共5页Journal of Peking University:Health Sciences

摘　　要：目的:研究腮腺手术术中面神经监护的方法和特点,并评价其作用。方法:92例腮腺肿物患者分为术中监护组和对照组各46例,均采用腮腺肿物及部分腺体切除术+面神经解剖术,记录手术时间及术后面神经功能。监护组术中采用4导联实时监护,通过直接电刺激和自由肌电图辅助定位面神经,对照组术中不行面神经监护。结果:13例原发肿瘤患者(监护组6例,对照组7例)术中面神经分支与肿瘤无关,监护组手术时间为(50.0±9.1)min,对照组手术时间为(42.9±5.2)min(P=0.064)。65例原发肿瘤患者(监护组32例,对照组33例)术中需要解剖分离面神经,监护组手术时间为(74.7±28.0)min,对照组为(75.6±29.8)min(P=0.893)。复发肿瘤患者14例,监护组8例,手术时间为(117.5±37.8)min;对照组6例,手术时间为(175±47.8)min,监护组手术时间较对照组明显缩短(P<0.05)。92例患者中,监护组8例出现面瘫症状,均因为肿瘤原因;对照组6例出现面瘫症状,4例因为肿瘤原因,2例为手术误伤。结论:术中面神经监护是辅助辨认和保护面神经的有效方法,应用术中神经监护能够降低复发腮腺肿瘤的手术时间,降低术中误伤神经风险,但不能明显降低术后面瘫的发生率。Objective ：To analyze the benefits of facial nerve electromyographic monitoring during pa- rotid tumor surgery. Methods：In the study, 92 patients with parotid tumor who underwent surgery were surveyed. The study group consisted of 46 patients who underwent intraoperative electromyographic monitoring, and 46 patients served as the control group. The incidence of postoperative facial nerve weakness and the operation time were recorded. Results：In the primary parotid tumor resection, the operation time of the study group （ 6 cases） was （50.0 ±9.1 ） min, that of control group （7 cases） was （42.9 ± 5.2 ） min （P = 0. 064） when the facial nerve needed no dissecting ; the operation time of the study group （32 cases）was （74.7±28.0） min, that of control group （33 cases） was （75.6±29.8） min （P = 0. 893 ） when the facial nerve needed dissecting. For the patients with revision surgery, the mean operation time in the study group [ （ 117.5± 37.8 ） min] was significantly lower than that of the control group [ （ 175.0 ± 47.8） rain ], P 〈 0.05. In the study group, 8 patients suffered from postoperative facial nerve weakness because of tumor characteristics; in the control group, 6 patients suffered from postoperative fa- cial nerve weakness, with 4 cases because of tumor characteristic, and 2 cases because of operator error. Conclusion： The results suggest that continuous electromyographic monitoring of facial nerve during parotid- ectomy reduces the mean operation time in patients with revision surgery, but not the incidence of postoperative facial paralysis.

关 键 词：腮腺肿瘤 面神经 监测 手术中 

分 类 号：R739.87[医药卫生—肿瘤]