耳后发际入路内镜辅助腮腺浅叶切除术的解剖研究  

Endoscope-assisted superficial parotidectomy via retroauricular hairline approach:anatomical study

作　　者：陈良嗣[1] 黄晓明[2] 梁璐[1] 张贝[1] 卢仲明[1] 罗小宁[1] 张思毅[1] 

机构地区：[1]广东省人民医院(广东省医学科学院)耳鼻咽喉头颈外科,广州510080 [2]中山大学孙逸仙纪念医院耳鼻咽喉头颈外科

出　　处：《临床耳鼻咽喉头颈外科杂志》2014年第21期1672-1675,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：广东省医学科研基金(No:A2011029);广东省科技计划项目(No:2011B080701035)

摘　　要：目的:为耳后发际入路内镜辅助腮腺浅叶切除术提供解剖学依据,并评价其可行性和安全性。方法:新鲜尸体15具(30侧),观测耳后发际区和腮腺区的解剖层次及重要结构;新鲜尸体5具(10侧),模拟内镜手术,术后解剖标本,观察有无神经、血管等损伤。结果:耳后发际区的分离层面在表浅肌肉腱膜系统与颈深筋膜浅层之间。胸锁乳突肌上部浅面由后上至前下依次为枕小神经、耳大神经、颈外静脉。耳大神经分支点至耳垂根部距离为(22.85±2.01)mm。腮腺区皮瓣的分离层面在咬肌筋膜与腮腺实质之间。面神经出茎乳孔,经茎突根部的浅面、外耳道软骨与二腹肌后腹之间进入腮腺。面神经总干分叉点与乳突尖距离为(19.10±3.10)mm,与下颌角距离为(39.49±5.78)mm。耳后动脉起自二腹肌后腹上方的颈外动脉后壁,主干跨面神经总干浅面。10侧模拟内镜手术顺利完成,术中无重要结构损伤,无需中转切口。结论:熟悉耳后发际区和腮腺区的解剖层次、标志及参数,耳后发际入路内镜辅助腮腺浅叶切除术安全、可行。Objective：To provide anantomical basis for the endoscope-assisted partial superficial parotidectomy via retroauricular hairline approach（EASPRHA）and assess its feasibility and safety.Method：The surgical anatomy of retroauricular hairline region and parotid gland region were observed in 15 fresh human cadavers（30halves）.The EASPRHA was performed on 5human cadavers（10halves）.After the procedure,the related vascular and neural structures were evaluated.Result：The retroauricular hairline region extends between superficial musculoaponeurotic system and superficial cervical fascia.On the superficial surface of the upper sternocleidomastoid lie the lesser occipital nerve,the great auricular nerve and the external jugular vein.The bifurcation of great auricular nerve is（22.85±2.01）mm from the bottom of earlobe.The parotid gland region extends between parotidomassteric fascia and parotid gland parenchyma.The facial nerve emerging from the stylomastoid foramen runs across the superficial surface of base of styloid process,passes through the interspace between cartilage of external acoustic meatus and posterior belly of digastric muscle,and enters the parotid gland.The bifurcation of facial nerve trunk is（19.10±3.10）mm from the mastoidale and（39.49±5.78）mm from the mandibular angle.Above the posterior belly of digastric muscle,the posterior auricular artery arises from the posterior wall of the external carotid artery with its main stem running over the superficial surface of facial nerve trunk.In all endoscopeassisted operations,the partial superficial parotidectomy was successful without the need for an additional incision.No major neurovascular damage wasobserved.Conclusion：A thorough knowledge of the surgical anatomy of retroauricular hairline region and parotid gland region is an essential requirement in performing the safe and feasible EASPRHA.

关 键 词：耳后发际入路 内镜术 腮腺 解剖 手术 

分 类 号：R322.9[医药卫生—人体解剖和组织胚胎学]