螺旋水刀在腮腺肿瘤手术中的应用

Application of Helix Water Jet to Parotid Surgery

背景与目的:安全有效地解剖面神经是成功完成腮腺肿瘤手术和减少术后并发症的关键。本研究旨在探讨应用a螺旋水刀进行腮腺肿瘤手术的可行性。方法:以2004年2月至2005年2月在中山大学肿瘤防治中心应用螺旋水刀完成腮腺手术的43例腮腺肿瘤患者为研究对象,对照组为同期采用传统手术方式治疗的36例腮腺肿瘤患者。比较两组手术时间、术后引流量、术后住院天数,及面瘫和涎瘘等并发症的发生率。结果:螺旋水刀组和对照组术后引流量差异具有统计学意义[(9.89±3.74)mL vs.(12.15±2.11)mL,P<0.05],手术时间[(90.28±25.30)minvs.(76.32±20.74)min]和术后住院天数[(6.39±1.38)d vs.(6.45±1.05)d]差异无统计学意义(P>0.05)。螺旋水刀组6例(14.0%)Ⅱ级面瘫,1例(2.3%)Ⅲ级面瘫,无涎瘘发生;对照组5例(13.9%)Ⅱ级面瘫,2例(5.6%)Ⅲ级面瘫,1例(2.8%)Ⅳ级面瘫,1例(2.8%)涎瘘。两组均无发生永久性面瘫患者,并发症的发生率差异也无统计学意义(P>0.05)。9例保留耳大神经患者术后有轻微的耳垂麻木症状。结论:螺旋水刀行腮腺手术安全可靠,是传统手术方式的有益补充。

BACKGROUND ＆ OBJECTIVE- Dissecting the facial nerves safely is an important guarantee for the accomplishment of parotidectomy and reduction of postoperative complications. This study was to explore the application of helix water jet to parotidectomy. METHODS. Clinical data of 43 patients with parotid tumors, who received operation with helix water jet from Feb. 2004 to Feb. 2005 at Cancer Center of Sun Yat-sen University, were analyzed. Meanwhile, traditional techniques in parotidectomy was performed in 36 patients （control group）. Duration of operation, postoperative drainage volume, postoperative hospitalization, and occurrence of postoperative complications, such as facial nerve dysfunction and salivary fistula, of the 2 groups were compared. RESULTS： The postoperative drainage volume was significantly lower in water jet group than in control group [（9.89±3.74） mL vs. （12.15±2.11） mL, P〈0.05]. There were no significant differences in duration of operation [（90.28±25.30） min vs. （76.32±20.74） min, P〉0.05], postoperative hospitalization [（6.39±1.38） days vs. （6.45±1.05） days, P〉 0.05] between the two groups. Of the 43 patients in water jet group, 6 （14.0%） had grade Ⅱ facial nerve dysfunction and 1 （2.3%） had grade Ⅲ facial nerve dysfunction; of the 36 patients in control group, 5 （13.9%） had grade Ⅱ facial nerve dysfunction, 2 （5.6%） had grade Ⅲ facial nerve dysfunction, 1 （2.8%） had grade Ⅳ facial nerve dysfunction and 1 （2.8%） had salivary fistula. There was no permanent facial nerve dysfunction occurred in both groups. There was no significant difference in the occurrence of complications between the two groups. Nine patients who retained nervus auricularis magnus suffered from slight numbness symptom of auricular Iobule. CONCLUSION： Use of helix water jet in parotid surgery is safe and confers some advantages over conventional methods of parotid dissection.