游离和非游离保留表浅肌肉腱膜在降低腮腺肿瘤术后复发及Frey综合征的临床应用  

Free or Non Free Preservation of Superficial Musculoaponeurotic System in Parotidectomy and its Role in the Prevention of Frey's Syndrome and Tumor Recurrence

作　　者：刘秉尧[1] 曹罡[1] 董震[1] 陈伟[1] 徐金科[1] 罗婷苑 张森林[1] 

机构地区：[1]南京军区总医院口腔科,江苏南京210000

出　　处：《口腔颌面外科杂志》2016年第4期264-268,共5页Journal of Oral and Maxillofacial Surgery

基　　金：国家自然科学基金(81102051)

摘　　要：目的:探讨腮腺肿瘤手术患者采用游离或非游离方式保留面部表浅肌肉腱膜系统(SMAS),对降低患者术后肿瘤复发及味觉出汗综合征(Frey综合征)发生率的作用。方法:2010—2012年,在收治腮腺肿瘤患者时,采用随机数字表法,将共90例患者随机分为3组。A组为游离保留SMAS术式、B组为非游离保留SMAS术式、C组为传统手术方法不保留SMAS,每组各30例。对比3组患者术后第6、12、18、24个月的Frey综合征发生率;术后2年随访比较3组患者腮腺肿瘤复发率的差异。结果:主观评价Frey综合征发生率,C组为50%,显著高于B组和A组;B组为23.33%,显著高于A组(3.33%),P<0.05。Frey综合征发生率A组为6.67%、B组为30.00%、C组为66.67%,组间比较C组>B组>A组,差异均具有统计学意义(P<0.05)。3组患者术后2年随访,A组复发2例,1例为腮腺混合瘤患者、1例为腺淋巴瘤,复发率为6.67%;B组复发3例,1例低度恶性黏液表皮样癌、2例腺淋巴瘤,复发率为10%;C组复发2例,1例低度恶性黏液表皮样癌患者,1腮腺混合瘤患者,复发率为6.67%。3组患者的术后复发率比较,差异无统计学意义(P>0.05);3组患者腮腺肿瘤复发中位时间比较,差异不具有统计学意义(P>0.05)。结论:腮腺肿瘤手术治疗患者采用游离保留SMAS术式,可有效降低术后Frey综合征的发生率,且不增加患者的术后复发率。Objective： The present review was done by comparing free reservation of superficial musculoaponeurotic sys-tem （SMAS） vs non free reservation of SMAS advancement flap in parotidectomy to compare the outcome like Frey syn-drome and recurrence rate. Methods： A retrospective randomized study was conducted. A total of 90 consecutive patients were included in this study. In group A, 30 patients were operated by free SMAS. In group B, 30 patients were operated by non free SMAS. And in group C, 30 patients were operated by traditional method, with no reservation of SMAS. Patients were followed up for a period of two years. The incidence of Frey＇s syndrome and tumor recurrence rate were compared. Results： Frey syndrome incidence was relatively higher in group C（50%）, than in group B （23.33%） and group A （3.33%）, which was statistically significant （P〈0.05）. Tumor recurrence was 2 cases in group A, 3 cases in group B, and 2 cases in group C respectively, without any significant difference. Conclusion： Surgical treatment of parotid tumor patients with free SMAS can effectively reduce the incidence of postoperative Frey syndrome, without recurrence rate increasing.

关 键 词：腮腺肿瘤 面部表浅肌肉腱膜系统 FREY综合征 

分 类 号：R739.8[医药卫生—肿瘤]