耳屏切口切除耳前腮腺良性肿瘤后应用拱顶石腮腺筋膜瓣修复组织缺损的疗效观察  

Efficacy of keystone parotid fascial flap on repairing tissue defect after resection of preauricular benign parotid tumor via tragal incision

作　　者：骆书文 仝春实 马欣 LUO Shu-wen;TONG Chun-shi;MA Xin(Department of Stomatology,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省人民医院,郑州大学人民医院口腔科,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2023年第5期460-463,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20220038);河南省医学科技攻关计划软科学项目(RKX202202012);河南省医学教育研究项目(Wjlx2022022)。

摘　　要：目的 观察拱顶石腮腺筋膜瓣在耳屏切口耳前腮腺良性肿瘤切除术后组织缺损修复中的应用效果,探讨其安全性。方法 耳前腮腺良性肿瘤患者19例,均采用耳屏切口行肿瘤包膜外切除术或聚焦肿瘤外切除术,肿瘤切除后于创面下方区域沿腮腺筋膜表面分离翻起面部皮瓣,制备包含腮腺筋膜及腮腺组织的拱顶石腮腺筋膜瓣进行组织缺损修复。观察术后出血、感染、涎瘘、面神经损伤、耳大神经损伤、组织瓣坏死发生情况。随访3个月,记录患者肿瘤复发及Frey’s综合征发生情况,观察腮腺导管口唾液分泌情况评估腮腺分泌功能,记录末次随访时切口瘢痕评分和外观凹陷畸形评分。结果 19例患者均顺利完成肿瘤切除术和拱顶石腮腺筋膜瓣组织缺损修复术,行肿瘤包膜外切除术17例,聚焦肿瘤外切除术2例,5例因组织缺损过大联合传统腮腺筋膜瓣修复;术后均未发生出血、感染、组织瓣坏死、面神经损伤、耳大神经损伤等并发症;1例发生涎瘘者给予阿托品抑制唾液腺分泌及腮腺区绷带加压包扎,2周后恢复正常,余患者一期愈合后出院。随访至2022年11月,19例肿瘤均未复发,均未发生Frey’s综合征,患侧腮腺唾液分泌功能均恢复。末次随访时切口瘢痕评分(0~2)分,外观凹陷畸形评分(0~1)分,患者均对面部凹陷修复效果满意。结论 拱顶石腮腺筋膜瓣用于耳屏切口耳前腮腺良性肿瘤切除术后组织缺损修复效果好,安全可靠。Objective To observe the efficacy of keystone parotid fascial flap on repairing tissue defects after the resection of preauricular benign parotid tumor via tragal incision,and to explore its safety.Methods Nineteen patients with preauricular benign parotid tumors underwent extracapsular dissection via tragal incision approach or focused extra-tumor excision.After tumor removal,the facial flap was separated along the surface of the parotid fascia in the area below the wound.A keystone parotid fascial flap containing the parotid fascia and parotid tissues was prepared for tissue defect repair.The complications as postoperative bleeding,infection,salivary fistula,fascial nerve injury,great auricular nerve injury and flap necrosis were observed.The patients were followed up for 3 months.The recurrence of the tumor and the occurrence of Frey's syndrome were recorded,and salivary secretion at the parotid duct outlet was observed to assess the parotid secretion function.The incision scar score and the appearance depression deformity score were recorded at the final follow-up.Results All 19 patients completed successfully tumor resection and keystone parotid fascial flap defect repair via tragal incision,in which 17 patients received extracapsular dissection,and 2 received focused extra-tumor resection.Five patients received additional conventional parotid fascial flap repair due to excessive tissue defect.There were no postoperative complications such as bleeding,infection,flap necrosis,facial nerve injury or great auricular nerve injury.All patients were discharged after primary healing except one patient who developed a salivary fistula after surgery and returned to normal after 2 weeks of inhibition of salivary gland secretion by atropine and pressure dressing with a bandage in the parotid area.The follow-up till November 2022 showed that no recurrence or Frey's syndrome developed and the salivary secretion function of the affected parotid gland was restored.At the final follow-up,the incision scar score was 0 to 2,t

关 键 词：腮腺良性肿瘤 拱顶石腮腺筋膜瓣 耳屏切口 腮腺功能 组织缺损修复 

分 类 号：R739.87[医药卫生—肿瘤]