腮腺良性肿瘤手术中耳大神经的解剖与保留

Modified parotidectomy based on anatomical reservation of the great auricular nerve

目的：对腮腺良性肿瘤患者耳大神经进行解剖、保留，由此提高患者术后生活质量。方法：2001年9月～2006年6月以改良术式治疗成年腮腺良性肿瘤患者20例，术中解剖、保留耳大神经；对耳大神经的位置、毗邻关系、直径、走行、分支、分布等解剖要素进行解剖观察，保留耳大神经主干及耳后、耳垂、耳前支，腮腺支部分或全部切除。术后观察、随访，了解术区及面神经恢复情况、肿瘤有无复发、耳大神经支配区感觉恢复情况。结果：耳大神经的分支、分布有其规律性。耳大神经在下颌角水平之上0～2cm依次分为耳后支、耳垂支、耳前支、腮腺支，神经主干末段和分支起始段均分布于腮腺筋膜浅层表面。术后患者有暂时性的外耳廓区轻度麻木，术后1周～4月后患者的外耳廓感觉基本恢复正常，无1例发生外耳廓区皮肤长期麻木。患者在面神经功能恢复、肿瘤复发、术区外形等方面与常规术式无明显差异。结论：耳大神经及各分支具有不可代替的解剖生理功能，改良术式能将其较好保留，显著降低术后并发症，提高患者生活质量。

Objective：To improve the patient＇qulity of life aftet surgery ,we modify the traditional parotidectomy based on anatomical reservation of the great auricular nerve on patients underwent parotid benign tumor .Methods： Twenty patients with parotid benign tumor who underwent modified parotidectomy surgical resection between 2001 and 2006 were included in this study. The great auricular nerve was dissected and reserved. The anatomy essences of the great auricular nerve such as position, adjacent, diameter, courser, branches and distribution were observed. The trunk and the post aurem, auricular lobule, anterior auricular branches of great auricular nerve were reserved, parorid branches were partly or totally resected. Through observation and follow - up visit after operation, the recovery informarion of operation region, facial nerve, and the sensory recovery information innervated by great auricular nerve were surveyed, Results ： The regularity of branches and distributions of great auricular nerve was observed. From 0 ～ 2 cm levels upper mandibular angle, the great auricular nerve distributed into post aurem, auricular lobule, anterior auricular, and parotid branches one by one. End - piece of nerve trunk and initial segment of branches were both distributed on the surface of superficial layer of fascia parotidea. Patients after operation had temporary light anaesthesia of auricular region and the aesthesia of auricular.region became normal from 1 week to 4 months after operation. No long - term anaesthesia of auricular region was found. There was not obvious difference between modified and normal parotidectomy in facial nerve function recovery, tumor recurrence, and the shape of operation region. Conclusion： The great auricular nerve and it＇s branches each has physiologic function unreplaceable. The modified parotidectomy can reserve them better, degrade postoperative complications significantly, and improve the patient＇s quality of life.