隐蔽小切口内镜辅助下腮腺良性肿瘤切除术

Endoscope-assisted parotidectomy for benign tumors via a short hidden auricular incision

目的 探索借助内镜经小切口在窄小人造腔室内实施腮腺手术的可行性和相关技术。方法 省略经典切口的颌下及大部分颌后段 ,保留其耳前部分和耳垂根下一弧形小段。前者后移至耳屏缘 ,后者不超过耳垂遮盖。切口长 3 5～ 5 5cm(平均 4 5cm)。采用分离 提吊 扩撑法先建起腺体上、后两个腔室 ,然后通过内镜视野 ,按面神经顺行解剖法和新建高频超声刀组织凝 切直断法操作。结果 良性肿瘤患者 2 6例肿瘤均被完整切除。除 1例出现暂时性口角歪斜外 ,余患者无面瘫 ;结论 借助内镜和改进技术 ,可经小切口在窄小人造腔室内安全实施腮腺手术。由于切口大幅压缩且被置于视觉盲区 ,不仅创伤明显减少 。

Objective To evaluate a technique of endoscope assisted parotidectomy for benign tumor via a short hidden auricular incision. Methods Twenty six volunteer patients were selected for the new approach, 16 with mixed tumor, 9 Warthin's tumor and 1 lymphoepithelial cyst. The tumor size was 1.6～3 cm(average 2.2 cm) and the incision ranged 3.5～5.5 cm(average 4.5cm) divided into two parts: 1)basic segment—started from anterio superior crease of tragus, went downward along tragal margin and pre earlobial fold, and stopped at earlobe root;2) extended segment—went from earlobe root, curved down posterio inferiorly. The length of the latter was generally not beyond 1 cm. The procedure began with raising the myo cutaneous flap and dissecting the whole posterior portion of the gland. Thus, two working spaces needed for endoscopic manipulation could be artificially created with suitable retracting instruments. Endoscopic view was then established, and the surgeons operated continuously in the later steps. Modified techniques, such as the antegrade facial nerve dissection, retrograde great auricular nerve dissection and direct coagulate cut method with ultrasonically activated scalpel, were employed to archive the goals of endoscopical nerve preservation and tissue resection. Results\ All tumors were entirely removed. No postoperative paralysis occurred , excepting 1 case who suffered from an temporary paralysis for two months. The appearance was good due to overlapping the short scar onto the irregular line of auricular contour and hiding its lowest part in the earlobe shadow. Conclusions\ Parotidectomy for benign tumors could be safely done via a much shortened incision, assisted by an endoscope. The postoperative stress of patients can be obviously reduced with the minimally invasive manipulation and the good appearance.