腮腺肿瘤的治疗经验及远期疗效观察

Management of the parotid gland tumor and its long-term outcome

目的手术治疗腮腺肿瘤的多种方法及其远期疗效评定。方法回顾性分析我科自1997～2004年所收治的腮腺肿瘤手术患者病历资料86例,男性53例,女性33例,年龄23～84岁,中间年龄57岁。所有患者都作腮腺浅叶切除术或浅叶扩大切除术或腮腺全切除术,必要时作颈清扫术。常规术中快速冰冻和术后病理检查。术后面神经功能评定。恶性肿瘤患者辅助性根治放疗(50 Gy～70 Gy)。有效随访期36～120个月不等。结果86例腮腺肿瘤患者中良性肿瘤73例(85%),恶性肿瘤13例(15%)。8例腮腺深叶肿瘤中5例为恶性肿瘤。随访中良性肿瘤1例局部复发,局部控制率为98.6%(72/73);恶性肿瘤3年生存率为69.2% (9/13),3年原发灶局部控制率为84.6%(11/13),术后颈淋巴结转移率为23.1%(3/13)。术中快速冰冻与术后常规病理符合率为86%,腮腺良性肿瘤的面神经完好保存率为97.3%(71/73),恶性肿瘤面神经完好保存率为69.2%(9/13),总体面神经完好保存率为93%。结论腮腺浅叶切除术是常规基本术式,根据肿瘤具体情况可改变为腮腺浅叶扩大切除术或全腮腺切除术。术中应尽可能保存面神经主干及各分支,特别是颞面干。快速冰冻是腮腺手术中的有效诊断方法。腮腺深叶肿瘤恶变率高。

OBJECTIVE To discuss the surgical methods and their long term efficacy of management of the parotid tumor. METHODS The clinical data of 86 cases with parotid tumor underwent operation between 1997 and 2004 in our hospital were retrospectively analyzed. There were 53 male and 33 female with their age from 23 to 84 years （mean 57 years old）. All the patients underwent superficial parotidectomy or extensive superficial parotidectomyenl or total parotidectomy. Selective or functional neck dissection was carried out in some cases. The function of facial nerve was evaluated after operation in all patients. Postoperative radiotherapy was performed in all malignant cases with a dose of 50 to 70 Gy. The patients were followed-up for 36 to 120 months. RESULTS There were 73 benign cases and 13 malignant cases. Five of 8 malignant tumors were found in deep lobe gland. Only one benign tumor locally recurred. The localregional control rate of the benign tumor was 98.3%. The 3-year survival rate and local-regional control rate in malignant neoplasm were 69.2 % and 84.6 % respectively. The cervical lymph nodes metastasis rate was 23.1% in postoperative pathologic study. The facial nerve preservation rates were 97.3 % and 69.2 % in benign and malignant cases respectively. CONCLUSION The superficial parotidectomy is the basic surgical method. Extensive superficial parotidectomy or total parotidectomy can be used if necessary. The facial nerve and its branches should be preserved during operation. The malignant tumor is more frequently found in deep lobe of the parotid gland.