首先识辨二腹肌支神经的离心法腮腺肿瘤切除术41例临床分析

41 Cases with Parotid Surgery by Centrifugation

目的探讨腮腺肿瘤手术的合理方法。方法根据CT、术前病史及面神经电图(ENoG)评估,以首先识辨二腹肌支神经的离心法面神经解剖+多种方式的腮腺及肿瘤切除,必要时扩大切除并颈廓清术等4种方案治疗腮腺肿瘤患者41例43侧。结果术后失访1例,6个月内死于远隔转移1例,死于其他疾病1例。38例(40侧)经6个月～6年随访,暂时性面瘫发生率为7.5%(3侧),永久性面神经功能H-BⅢ级发生率为5.0%(2侧),H-BⅣ级发生率为2.5%(1侧)。术后肿瘤局部复发率为2.5%(1侧)。术后无涎漏、出血、Frey综合征等并发症的发生。结论离心法腮腺肿瘤切除以首先识辨二腹肌支神经的离心法面神经解剖为关键,经4个方案切除腮腺及其肿瘤,适合于绝大部分腮腺肿瘤,在保全面神经功能、减少肿瘤复发等方面有明显优势。

Objective To investigate the feasibility of parotid surgery by centrifugation and its effect on tumors of parotid gland.Methods Forty one patients（43 sides） with tumors of parotid gland received parotid surgery by centrifugation.Facial nerve of every side was dissected by centrifugation method which identified first digastric branch of facial nerve.Four surgical schemes were performed according to case history,CT scanning and ENoG before operations.Results After operation,1 patient failed to follow up,1 died of distant metastasis,1 of other disease.In 38 patients（40 sides） after 6-month～6-year follow up,the incidence of temporary facial paralysis was 7.5%（3 sides）,that of permanent facial nerve function H-B Ⅲ level was 5.0%（2 sides）,H-B IV incidence was 2.5%（1 side）.After operation,tumor local recurrence was 2.5%（1 side）,no complications such as salivary leakage,bleeding,Frey syndrome,etc.occurred.Conclusion Centrifugal facial nerve dissection identifying first digastric branch nerve is the key of parotid surgery by centrifugation.Four schemes on resection of parotid glands and tumors,suitable for most parotid tumors,are of obvious advantage in protection of facial nerve function and reduction of tumor recurrence.