腮腺复发性肿瘤的手术方式及临床观察  

Surgical method and clinical observation of recurrent parotid gland tumor

作　　者：徐艳[1] 杨见明[1] XU Yan;YANG Jianming(Department of Otorhinolaryngology Head and Neck,The Second Affiliated Hospital of Anhui Medical University,Hefei,Anhui 230601,China)

机构地区：[1]安徽医科大学第二附属医院耳鼻咽喉头颈外科,合肥230601

出　　处：《中国中西医结合耳鼻咽喉科杂志》2020年第1期50-52,共3页Chinese Journal of Otorhinolaryngology in Integrative Medicine

摘　　要：目的探讨腮腺复发性肿瘤的病理类型、再次手术的方式及术后并发症。方法对2015~2018年我科腮腺复发性肿瘤14例患者的再次手术方式及并发症进行回顾性分析,追踪临床随访情况。结果14例患者术后复发时间半年到30年不等,7例为多形性腺瘤,其中1例恶变,其余病理包括血管性疾病、腺淋巴瘤、囊肿、木村病、腺癌等;12例为第2次手术,2例为第3次手术;10例患者行腮腺浅叶切除,4例患者行全腮腺切除,3例行放疗治疗;主要并发症为暂时性面瘫7例,持续性面瘫2例,涎瘘2例,Frey综合征1例。1例行3次手术患者复发肿瘤瘢痕组织与面神经分界不清,予以保留面神经,术后病理证实切缘为瘢痕纤维组织,未见肿瘤细胞。随访期间所有病例未见肿瘤复发。结论腮腺复发性肿瘤以多形性腺瘤最常见,再次手术建议采用浅叶或全腮腺切除,避免区域性切除,减少复发。多次手术解剖困难,神经损伤几率增加,术中可使用神经监护仪,利于神经保护。Objective To investigate the pathologic types and postoperative complications of recurrent parotid gland tumors.Methods We retrospectively analyzed the surgical methods,complications and postoperative follow-up of 14 patients with recurrent parotid gland tumor treated in our department from 2015 to 2018.Results Among the 14 patients,postoperative recurrence time varies from half a year to 30 years;7 cases had pleomorphic adenoma with 1 case had malignancy transformation and the rest cases had pathologic diagnosis of vascular disease,adenolymphoma,cyst,kimura disease and adenocarcinoma.Twelve cases were the second surgery and 2 cases were the third surgery.Ten cases had superficial parotid gland resection and 4 cases had total lobe resection;3 cases received radiotherapy.The main complications were temporary paralysis in 7 cases,persistent paralysis in 2 cases,salivary gland leakage in 2 cases,Frey syndrome in 1 case.The boundary between recurrent tumor scar tissue and facial nerve was not clear in the patient who underwent the third surgery,and the facial nerve was preserved.Postoperative pathology confirmed that the incised margin was scar fibrous tissue,and no tumor cells was found.No tumor recurrence was found in all patients during the follow-up.Conclusions Pleomorphic adenoma is the most common type of recurrent parotid gland tumor.Superficial or total lobectomy is recommended for reoperation to reduce recurrence,and regional resection is not recommended.The risk of facial nerve injury is increased in those cases with multiple surgery history.Intraoperative nerve monitor should be used for nerve protection.

关 键 词：腮腺肿瘤 复发 病理 手术方式 

分 类 号：R739.87[医药卫生—肿瘤]