手术治疗累及侧颅底复发性腮腺恶性肿瘤的回顾性研究  

A Retrospective Study of Surgical Treatment of Recurrent Parotid Malignancy Involving Lateral Skull Base

作　　者：寇家豪 许慧霞 吴朱昊 孙国文[1] KOU Jiahao;XU Huixia;WU Zhuhao;SUN Guowen(Nanjing Stomatological Hospital,Affiliated Hospital of Medical School,Institute of Stomatology,Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属口腔医院,南京市口腔医院,南京大学口腔医学研究所,江苏南京210008

出　　处：《口腔医学研究》2025年第4期301-305,共5页Journal of Oral Science Research

基　　金：南京市卫生科技发展专项资金项目(编号:YKK22183)。

摘　　要：目的:总结累及侧颅底复发性腮腺恶性肿瘤的临床表现、诊断及手术治疗方法,为临床诊疗积累经验。方法:收集2019年9月~2024年9月南京大学附属口腔医院一病区收治的累及侧颅底复发性的腮腺恶性肿瘤患者的临床资料及治疗方法进行回顾性分析。结果:9例患者均行手术治疗,切除范围包括病灶及病灶累及的颧骨颧弓、颞肌、髁突、咬肌、翼内外肌、部分外耳道等结构,手术切除达侧颅底,其中2例是在计算机导航辅助引导下切除病灶,术后组织缺损有2例行邻近瓣修复,7例行股前外侧肌皮瓣修复,皮瓣术后均存活。结论:累及侧颅底复发性腮腺恶性肿瘤手术治疗较为复杂,涉及众多重要解剖结构,包括腮腺床、翼内外肌、翼丛、三叉神经、颧骨颧弓、颌骨等,且复发后组织结构变形,术前应对肿瘤范围、累及解剖结构有清晰了解,针对肿瘤侵犯结构个性化设计方案,术中应当注意对出血进行控制,术后应当密切关注患者生命体征及皮瓣状况,并且辅以放化疗等。Objective:To summarize the clinical manifestations,diagnosis,and surgical treatment methods of recurrent malignant tumors of parotid gland involving lateral skull base.Methods:A retrospective analysis was conducted on the clinical data and treatment methods of patients with recurrent parotid gland malignant tumors involving the lateral skull base admitted to the First Ward of Nanjing University Affiliated Stomatological Hospital from October 2019 to October 2024.Results:All 9 patients underwent surgical treatment,with the resection scope including the lesion and the affected structures such as the zygomatic arch,temporalis muscle,condyle,masseter muscle,medial and lateral pterygoid muscles,and part of the external auditory canal.The surgical resection reached the lateral skull base,with 2 cases undergoing lesion resection under computer-assisted navigation guidance.Postoperative tissue defects were repaired with adjacent flaps in 2 cases and with anterior lateral thigh muscle flaps in 7 cases.All flaps survived after surgery.Conclusion:Surgical treatment for recurrent malignant tumors of the parotid gland involving the lateral skull base is relatively complex,involving numerous important anatomical structures,including the parotid bed,internal and external pterygoid muscles,pterygoid plexus,trigeminal nerve,zygomatic arch,jawbone,etc.After recurrence,tissue structure deformation should be observed.Before surgery,a clear understanding of the tumor scope and involved anatomical structures should be obtained,and personalized plans should be designed for tumor invasion structures.During surgery,bleeding should be controlled,and postoperative vital signs and flap condition should be closely monitored,supplemented by radiotherapy and chemotherapy.

关 键 词：复发性腮腺恶性肿瘤 侧颅底 手术安全切缘 计算机导航技术 

分 类 号：R739.8[医药卫生—肿瘤]