腮腺多形性腺瘤外科术式的演变及发展  

Development and history in parotid pleomorphic adenoma surgery

作　　者：刘洪[1] 李超[2] 王少新[2] 王薇[2] 樊晋川[2] 

机构地区：[1]广西医科大学研究生学院,南宁市530021 [2]四川省肿瘤医院头颈外科

出　　处：《中国肿瘤临床》2014年第9期604-607,共4页Chinese Journal of Clinical Oncology

基　　金：国家自然科学基金项目(编号：81302375);四川省科技厅计划项目(编号：2012JY0125);四川省卫生厅科研项目(编号：130230，110259)资助~~

摘　　要：腮腺肿瘤以多形性腺瘤居多,目前外科治疗仍是主要的治疗方式。20世纪时学者们由于对面神经解剖和多形性腺瘤包膜病理特性缺乏了解,该病的主要术式为单纯肿瘤剜除术,但术后容易导致复发;试图通过扩大切除的范围控制复发率,于是包膜外切除术开始运用于临床,虽然切除了肿瘤的包膜,但是复发率仍未能很好地控制。腮腺浅叶切除术和腮腺全切术明显降低了复发率,但是伴随着面神经损伤的加重,似乎又矫枉过正。腮腺部分切除术作为新的腮腺手术形式,不但降低了复发率、面神经损伤率,还得到病理学基础研究证据的支持,是目前较为先进的手术方式。但是在经典的腮腺浅叶切除术与先进的腮腺部分切除术之间仍存在争议。经过整形学、病理学、基因检测法等方面探究这两种手术的优劣均各有差异。本文从腮腺术式的演变历程探讨腮腺术式发展的方向。Pleomorphic adenoma ranks first among parotid gland tumors. Surgical procedure, which includes enucleation, ex-tra-capsular resection, partial superficial parotidectomy （PSP）, superficial parotidectomy （SP）, and total parotidectomy （TP）, remains to be the treatment of choice for pleomorphic adenoma. In the last century, physicians lacked understanding on the pathological character-istics of pleomorphic adenoma and facial neurotomia. Thus, simple enucleation of tumors has always been the major therapy for pa-tients to reduce the rate of facial nerve injury. However, postoperative recurrence was frequently observed in patients that have under-gone simple enucleation. In this study, the surgeons attempted to control the relapse rate by enlarging the scope of excision when remov-ing a pleomorphic adenoma, and by performing an extra-capsular resection procedure that was developed in the clinic. Although the tu-mor peplos was excised, the surgeons failed to control the relapse rate. SP and TP apparently decreased the relapse rate of the pleomor-phic adenomas. However, these therapies seem to be overcorrected by the aggravation of facial nerve injuries. PSP is a relatively ad-vanced technique that is currently used in parotid surgery. PSP reduces the rate of relapse and facial nerve injury, as verified by basic pa-thology research. Nevertheless, the controversy between advanced PSP and classic SP still exists. Plastic surgery, pathology research, and gene testing were used to evaluate the advantages of advanced PSP and classic SP. However, the research failed to derive a con-firmed result that can determine which treatment method is fit and unfit to treat pleomorphic adenoma. Our study reviews the trend of parotid surgery from a historic point of view.

关 键 词：多形性腺瘤 手术方式 腮腺肿瘤 外科学 

分 类 号：R739.8[医药卫生—肿瘤]