内镜辅助下腮腺切除术14例报道

Endoscopic-assisted parotidectomy:Report of 14 consecutive cases

目的:探讨内镜辅助下进行腮腺手术切除的临床效果。方法:对2004年10月-2006年9月就诊的15例腮腺肿物住院患者采用无注气内镜辅助下腮腺切除手术。通过耳垂后下方皮纹小切口,在颈深筋膜浅层,采用高频超声刀切割分离,远端借助监视器锐性分离,暴露腮腺浅叶。内镜下解剖面神经主干及分支,超声刀切除腮腺,伤口负压引流。结果:耳垂后下方切口长4.0～5.4cm,平均4.8cm。手术麻醉时间平均115min。腮腺浅叶切除3例,部分腮腺浅叶切除11例。术后病理诊断为多形性腺瘤8例,Warthin瘤4例,淋巴上皮病1例,淋巴结反应性增生1例。随诊6～31个月,平均14个月。面神经轻度麻痹5例,均在6个月内恢复正常。结论:内镜辅助下腮腺切除手术适用于腮腺浅叶良性肿瘤的切除,切口小且隐蔽,手术创伤小,有利于患者的恢复。

PURPOSE： The purpose of this study was to minimize surgical scar for cosmetic concerned patients of parotid benign diseases with the assistance of endoscopic surgery. METHODS： Fourteen selected patients with parotid benign diseases underwent parotidectomy with the assistance of endoscopic surgery from October 2004 to September 2006. The skin incision started from the tip of mastoid and then extended to the retromandibular sulcus along the skin crease. The facial flap was elevated and the endoscope working space was established with use of the harmonic scalpel. The main facial nerve trunk was dissected at the exit from the stylomastoid foremen. The tumor was removed by means of parotidectomy while the peripheral nerve branches were dissected accordingly with the assistance of endoscopic surgery. RESULTS： The incision length ranged from 4.0 cm to 5.4cm （mean 4.8cm）. The mean duration of surgery anesthesia was 115 minutes. Three patients underwent superficial parotidectomy, eleven patients underwent local superficial parotideetomy. There were 8 pleomorphic adenomas, four Warthin＇s tumors, one lymphoepithelial lesions, and one lymph node hyperplasia. The median follow up time was 14 months, five patients had transient facial paresis and recovered within 6 months. CONCLUSION： The advantage of endoscopic surgery is minimal postoperative scarring and is indicated for parotid benign tumor in the superficial lobe.