腮腺良性肿瘤改良术式的临床探讨

A clinical retrospective study on modified parotidectomy in benign tumors of parotid gland

目的:探讨腮腺良性肿瘤改良术式的临床效果及其合理性。方法:110例患者随机分为2组,一组行保留腮腺咬肌筋膜、保留耳大神经分支和腮腺部分切除术的腮腺良性肿瘤改良术式,另一组行传统腮腺浅叶或全叶切除术;术后随访2a。记录手术出血量、手术时间,临床检查暂时性面瘫和术后肿瘤复发,行Minor试验,问卷调查味觉出汗综合征发生率、耳垂区感觉及面部畸形情况。采用SPSS10.0软件包对数据进行t检验或χ2检验。结果:2组对比,腮腺良性肿瘤改良术式的出血量和手术时间显著低于传统腮腺浅叶切除术,术后暂时性面瘫、涎瘘和术后肿瘤复发率2组无显著差异。2组味觉出汗综合征的发生率,问卷调查和微量淀粉碘试验结果,均有统计学差异(P<0.05);保留耳大神经后支,耳垂区麻木症状发生率明显降低。结论:腮腺良性肿瘤改良术式可以减少手术出血量,缩短手术时间,显著减少味觉出汗综合征、耳垂区感觉障碍的发生率,患者术后面部畸形也获得良好改善。

PURPOSE： A clinical perspective study was designed for patients undergoing a modified parotidectomy to reduce complications of parotidectomy. METHODS： 110 patients were divided randomly into two groups; Group 1 （55 cases） was operated via routine surgical modality. Group 2 （55 cases） was treated with preserving the fascia parotideomasseterica and great auricular nerve and partial parotidectomy. Tumor size, blood loss, operating time, temporary facial paralysis, tumour recurrence were compared between the two groups. The follow-up period was 2 years. The incidence of Frey＇s syndrome was clinically evaluated by Minor test （starch-iodine test）. The feeling of the region around the auricular lobule was also evaluated. The data were analyzed using SPSS10.0 software package for Student＇s t test and Chi-square test. RESULTS： There was no significant difference between the two groups in tumor size, temporary facial paralysis and tumor recurrence. Group I was significantly lower than that in Group 2 in the bleeding volume and operating time. The incidence rate of Frey＇s syndrome in Group I was significantly lower than that in Group 2 by objective observation and Minor test. There was significant difference between the feeling of prooperation and pre-operation in the auricular lobule. CONCLUSIONS： The modified parotidectomy is a function-preserving surgery for benign parotid tumours, which improves the cosmetics, the feeling around ear, reduces the duration of surgery, and the incidence rate of Frey＇s syndrome. Supported by Research Fund of Science and Technology Bureau of Shanxi Province [Grant No. 2005K14-G8（2）] and Science and Technology Project of Xi＇an City [Grant No.SF08008-（4）].