腮腺深叶良性肿瘤:与定位和手术入路相关的分类  

Benign deep lobe parotid tumors:classification in association with localization and surgical approaches

作　　者：马学花 徐江[1] 夏飞飞 方桃莉 孙志鹏[2] MA Xue-hua;XU Jiang;XIA Fei-fei;FANG Tao-li;SUN Zhi-peng(Department of Stomatology,the First Affiliated Hospital of Shihezi University School of Medicine,Shihezi 832008,Xinjiang Uygur Autonomous Region;Department of Oral and Maxillofacial Radiology,Peking University School of Stomatology,Beijing 100081,China)

机构地区：[1]石河子大学第一附属医院口腔科,新疆石河子832008 [2]北京大学口腔医学院医学影像科,北京100081

出　　处：《上海口腔医学》2024年第4期387-392,共6页Shanghai Journal of Stomatology

基　　金：国家临床重点学科建设项目(PKUSSNKP-202111);北京大学口腔医学院临床新技术方案(PKUSSNCT-23A13)。

摘　　要：目的:腮腺深叶良性肿瘤(benign deep lobe parotid tumors,BDLPTs)具有多种临床表现和影像学特征,与选择合适的手术入路密切相关,本研究旨在探讨不同类型BDLPTs手术方式的差异。方法:选取2014年8月—2020年8月因腮腺区肿物就诊于北京大学口腔医院并行手术治疗且病理诊断为BDLPTs的75例患者,回顾性评估CT影像资料,根据肿瘤与各种结构的解剖关系将BDLPTs分为4类,探讨每种类型肿瘤的手术治疗方法。采用SPSS 24.0软件包对数据进行统计学分析。结果:Ⅰ型BDLPTs(14/75,18.7%)完全位于下颌支和茎突下颌间隙内侧,瘤体增大时突向咽旁间隙。Ⅱ型BDLPTs(19/75,25.3%)位于下颌后间隙,以下颌支、茎突下颌间隙、乳突和下颌后静脉为界。Ⅲ型BDLPTs(27/75,36.0%)呈膨胀型生长,横穿茎突下颌间隙,从下颌后静脉延伸至咽旁间隙。Ⅳ型BDLPTs(15/75,20%)位于耳垂下方、面神经和下颌后静脉深部。经下颌骨劈开入路主要用于Ⅰ型病例(10/14),Ⅲ型病例采用腮腺入路(14例)、下颌入路(11例)和腮腺-下颌联合入路(2例),Ⅱ型和IV型病例经腮腺入路同时行腮腺切除术。结论:BDLPTs分类可为术前制定治疗计划提供有价值的见解和实践指导。PURPOSE:Benign deep lobe parotid tumors(BDLPT)exhibit a wide range of clinical and imaging features,which closely correlated with the selection of appropriate surgical approaches.This study was aimed to explore variations in surgical management.METHODS:Seventy-five patients with primary BDLPT who underwent surgery in Peking University School and Hospital of Stomatology from August 2014 to August 2020 were included.The imaging data of all cases were retrospectively evaluated.BDLPTs were divided into four types according to the anatomical relationship between the tumor and various structures,and the surgical treatment of each type of tumor was studied.SPSS 24.0 software package was used for statistical analysis.RESULTS:TypeⅠBDLPT(14/75,18.7%)was located entirely medial to the ramus and the stylomandibular space,with growth extending towards the parapharyngeal space.TypeⅡBDLPT(19/75,25.3%)resided within the retromandibular space,bounded by the ramus,stylomandibular space,mastoid,and retromandibular vein.TypeⅢBDLPT(27/75,36.0%)exhibited an expansive growth pattern,extending from the retromandibular vein to the parapharyngeal space while traversing the stylomandibular space.TypeⅣBDLPT(15/75,20%)was situated inferior to the ear lobe,deep to the facial nerve and retromandibular vein.Transmandibular approach was predominantly employed in type I cases(10/14).TypeⅢcases utilized transparotid(14 cases),transmandibular(11 cases),and combined transparotid-transmandibular(2 cases)approaches.TypeⅡandⅣcases involved transparotid approaches with concurrent parotidectomy.CONCLUSIONS:The classification of BDLPT offers valuable insights and practical guidance for preoperative treatment planning.

关 键 词：腮腺 良性肿瘤 手术入路 

分 类 号：R782.05[医药卫生—口腔医学]