二腹肌后腹附着点定位面神经主干在腮腺肿瘤手术中的应用  

Application of locating facial nerve trunk at posterior abdominal attachment point of digastric muscle in parotid gland tumor surgery

作　　者：杜银娟 黄志纯[1] 王丽芬[1] DU Yinjuan;HUANG Zhichun;WANG Lifen(Department of Otolarngology Head and Neck Surgery,Zhongda Hospital,Southeast University,Nanjing,Jiangsu,210009,China)

机构地区：[1]东南大学附属中大医院耳鼻咽喉头颈外科,江苏南京210009

出　　处：《中国耳鼻咽喉头颈外科》2020年第10期556-558,共3页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨经二腹肌后腹附着点定位面神经主干的方法在腮腺肿瘤手术中的应用。方法回顾性分析2010年12月~2019年1月我科收治的108例腮腺肿瘤患者。观察组82例均采用以二腹肌后腹附着点定位面神经主干,对照组26例均采用经下颌缘支逆行法。其中观察组25例患者采用耳后发际联合耳屏前缘美容切口。结果所有患者均顺利解剖面神经并完整切除肿瘤,术后16例患者出现面瘫,观察组9例(10.9%),对照组7例(26.9%),观察组面神经损伤率明显低于对照组,差异有统计学意义(χ^2=3.978,P<0.05)。术后观察组和对照组各1例出现涎腺瘘,其余患者切口均 I期愈合。所有患者均无味觉出汗综合征、术后出血、口干等并发症,随访6个月以上,无肿瘤复发。结论在腮腺肿瘤手术中采用以二腹肌后腹附着点定位面神经主干的方法,能够快速准确定位面神经,减少相关并发症的发生,同时采用耳后发际美容切口,术后瘢痕隐蔽,美容效果良好,值得临床推广应用。OBJECTIVE To explore the value of application of locating the facial nerve trunk through the posterior abdominal attachment point of digastric muscle in parotid gland tumor surgery.METHODS 108 patients with parotid tumor treated in our department from December 2010 to January 2019 were analyzed retrospectively.The facial nerve trunk was located by the posterior abdominal attachment point of the digastric muscle in the observation group(n=82) and through the marginal branch of the mandible in the control group(n=26).In the observation group,25 patients were treated with aesthetic incision of posterior auricular hairline combined with front edge of tragus.RESULTSThe facial nerve was dissected and the tumor was completely removed in all patients.Facial paralysis occurred in 16 patients after operation,including 9 cases(10.9%) in the observation group and 7 cases(26.9%) in the control group.The facial nerve injury rate in the observation group was significantly lower than that in the control group(χ^2=3.978,P<0.05).One case of salivary gland fistula occurred in the observation group and the control group,and the other patients’ incisions healed in stage I.No complications such as gustatory sweating syndrome,postoperative bleeding and dry mouth were found in all patients after operation.All patients were followed up for more than 6 months,no tumor recurrences occurred.CONCLUSION In the operation of parotid gland tumor,the method of locating the facial nerve trunk with the attachment point of digastric muscle posterior abdomen can quickly and accurately locate the facial nerve and reduce the occurrence of related complications.At the same time,the hairline cosmetic incision behind the ear is adopted,which has hidden scar after operation and good cosmetic effect,which is worthy of clinical application.

关 键 词：腮腺肿瘤 面神经 外科手术 二腹肌 

分 类 号：R739.8[医药卫生—肿瘤]