超声刀辅助下腮腺良性肿瘤功能性包膜外切除术的临床效果评价  

Evaluation of harmonic scalpel assisted extracapsular dissection for benign parotid tumors

作　　者：郑重阳 张新宇[2] 曹锐[3] 刘浏[2] 胡永杰[2] ZHENG Chong-yang;ZHANG Xin-yu;CAO Rui;LIU Liu;HU Yong-jie(Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Huzhou University. Huzhou 313000, Zhejiang Province;Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine. Shanghai 200011;Department of Oral and Maxillofacial Surgery, Second People's Hospital of Changshu. Changshu 215500, Jiangsu Province, China)

机构地区：[1]湖州师范学院附属第一医院口腔颌面外科,浙江湖州313000 [2]上海交通大学医学院附属第九人民医院·口腔医学院,口腔颌面-头颈肿瘤科,上海200011 [3]常熟市第二人民医院口腔颌面外科,江苏常熟215500

出　　处：《上海口腔医学》2019年第4期402-407,共6页Shanghai Journal of Stomatology

基　　金：湖州市公益性应用研究项目（2017GY41）

摘　　要：目的:探讨超声刀辅助下功能性包膜外切除术(harmonic scalpel assisted extracapsular dissection,HS-ECD)治疗腮腺良性肿瘤的临床效果。方法:回顾分析2013-2017年3家医疗机构使用HS-ECD术式进行治疗且资料齐全的132例腮腺良性肿瘤患者,根据肿瘤位置分为浅叶耳屏前、浅叶下极、腮腺深叶组,收集术中、围术期各项指标和并发症发生率,以及随访期内肿瘤复发率。采用SPSS 16.0软件包对数据进行统计学分析。结果:深叶组手术时间与术后引流时间较长,术中失血量与引流量较多(P<0.01);深叶组面神经损伤概率较高(P=0.022),耳大神经损伤、腮腺筋膜损伤及肿瘤包膜破裂3组间无显著差异(P>0.05);深叶组术区皮肤感觉减退及涎瘘发生率较高(P=0.004、0.043);创口感染与味觉出汗综合征的发生率组间无显著差异(P>0.05);深叶组暂时性面瘫发生率显著升高(P<0.01),永久性面瘫发生率组间无显著差异(P=0.052);肿瘤复发率3组间无显著差异(P=1.000)。结论:HS-ECD术式对腮腺良性肿瘤患者效果良好。术中切口缩小,组织损伤减轻;术后面型良好,功能保存完善,术后并发症发生率有效降低,肿瘤复发率控制良好。PURPOSE:To investigate the clinical outcomes and prognosis of harmonic scalpel assisted extracapsular dissection for benign parotid tumors.METHODS:A total of 132 patients with full medical archives who were diagnosed as benign parotid tumors from 3 medical centers were retrospectively analyzed.The included patients were divided into 3 groups according to tumor positions,namely,superficial pre-auricular,superficial tail,and deep lobe.The intra-and perioperative variables,complications,functional outcomes and recurrence rates were analyzed with SPSS 16.0 software package.RESULTS:The surgical and drainage time were longer and the blood loss and drainage amount were significantly greater in deep lobe group(P<0.01).Facial nerve damage occurred more frequently in deep lobe group(P=0.022),while damages of great auricular nerve and parotid fascia,as well as capsule rupture were similar among 3 groups(P >0.05).More patients with decreased sensation or sialocele were observed in deep lobe group(P =0.004,0.043,respectively),and no significant differences were found for wound infection and Frey’s syndrome among 3 groups(P>0.05).Transient facial nerve paralysis occurred more frequently in deep lobe group(P <0.01),while permanent facial nerve paralysis was similar(P=0.052).No significant difference was observed for tumor recurrence(P=1.000).CONCLUSIONS:HS-ECD displays good outcomes and prognosis for benign tumor of parotid gland,with improved esthetic and functional results as well as fewer complications and recurrence rate postoperatively.

关 键 词：腮腺良性肿瘤 功能性外科 超声刀辅助下包膜外切除术 术后并发症 复发率 

分 类 号：R739.8[医药卫生—肿瘤]