功能性腮腺外科在腮腺良性肿瘤切除中的运用  

Functional parotid surgery for removal of benign parotid tumors

作　　者：毛涌[1] 常永军[1] 张晓林[1] 徐菲菲[1] 余少卿[1] 季振威[2] MAO Yong;CHANG Yongjun;ZHANG Xiaolin;XUFeifei;YU Shaoqing;JI Zhenwei(Department of Otorhinolaryngology Head and Neck Surgery,Tongji Hospital,Tongji University,Shanghai,200065,China;Department of Stomatology,Tongji Hospital,Tongji University)

机构地区：[1]同济大学附属同济医院耳鼻咽喉头颈外科,上海200065 [2]同济大学附属同济医院口腔科

出　　处：《临床耳鼻咽喉头颈外科杂志》2018年第23期1810-1812,共3页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨功能性腮腺外科在腮腺良性肿瘤切除中的临床运用,探索预防Frey综合征的方法。方法:对156例腮腺良性肿瘤(浅叶146例,深叶10例,肿瘤<4cm)做功能性腮腺外科切除术。肿瘤<2cm,安全切缘为5mm;肿瘤2~4cm,安全切缘为1cm。156例患者随机分为A、B两组,每组78例。A组肿瘤切除后,在残留腮腺表面与皮瓣之间置入可吸收止血海绵作为隔离物,B组不置入隔离物。术后随访12~24个月。结果:术后均未加压包扎,全部患者均无复发,无涎瘘;3例暂时性面瘫,其中2例下颌缘支损伤,1个月内面神经功能恢复,1例面神经主干损伤,术后6个月完全恢复。A组Frey综合征发生率3.85%(3/78),B组发生率15.38%(12/78),2组比较差异有统计学意义(χ~2=5.728,P<0.05)。结论:功能性腮腺外科切除术切除腮腺良性肿瘤能有效保存部分腺体功能,减少涎瘘、Frey综合征、面部凹陷畸形、耳垂麻木等并发症。术腔腮腺表面与皮瓣之间置入可吸收止血海绵,能进一步减少Frey综合征的发生。Objective:To evaluate the effect of the application of functional parotid surgery for removal of benign parotid tumors and the prevention of Frey syndrome.Method:One hundred and fifty-six cases with benign tumor were underwent functional regional parotidectomy.All tumors were smaller than 4 cm in diameter.The safe surgical margin was 5 mm when the tumors were less than 2 cm in diameter,while the safety margin was 1 cm for the tumors diameter between 2-4 cm.156 cases were assigned to two groups(A and B).The absorbable hemostatic sponge was placed between the surface of parotid gland and skin flap after tumor resection in group A,while no sponge was placed in group B.Postoperative follow-up was 12-24 months.Result:No compression bandage was performed.No patient had recurrence or salivary fistula.There were 3 cases of temporary facial paralysis,of which2 cases recovered from the mandibular marginal branch injury within 1 month and 1 case recovered from the facial nerve trunk injury within 6 months.Compared with group B 15.38%(12/78),the incidence of Frey syndrome was significantly decreased in group A 3.85%(3/78).χ~2=5.728,P<0.05.Conclusion:The removal of benign parotid tumors by functional parotid surgery can effectively preserve the function of residual gland and reduce complication.Intraoperative implantation of absorbable hemostatic sponge between parotid gland and skin flap can reduce the incidence of Frey syndrome.

关 键 词：功能性外科 腮腺肿瘤 腮腺切除术 出汗 味觉性 

分 类 号：R739.87[医药卫生—肿瘤]