美容切口联合胸锁乳突肌瓣在腮腺良性肿瘤手术中的应用(附18例临床报告)

Application of Esthetic Incision Combined with Sternocleidomastoid Flap in Operation on Parotid Benign Tumor of 18 Cases

目的尝试改良的腮腺手术切口,并结合胸锁乳突肌瓣填塞创腔,使腮腺肿瘤患者术后面部外形更加美观。方法对18例腮腺良性肿瘤患者(多形性腺瘤13例,腺淋巴瘤4例,腮腺囊肿1例),采用耳屏内侧缘切口向下至耳垂后延伸至发际并沿发际延伸的改良切口行腮腺区肿瘤及浅叶或部分浅叶切除+面神经解剖术,并切取近乳突处的胸锁乳突肌瓣填塞创腔,术后负压引流3～5 d。结果随访6～24个月,18例患者切口愈合良好,无感染,无涎瘘。3例患者出现暂时性面瘫,于术后3个月内恢复正常,其余患者未出现神经损伤症状。1例患者术后5个月出现Frey综合征,无术后复发病例。切口隐蔽,无明显凹陷,所有患者对术后切口美观满意。结论改良的腮腺手术切口用于腮腺浅叶良性肿瘤及浅叶或部份浅叶的切除较传统的"S"形切口更加美观、隐蔽,术中以胸锁乳突肌瓣填塞创腔对避免术区凹陷及预防Frey综合征有较好的作用。

Objective To Modify incision and sternocleidomastoid flap were used in parotidectomy and tumorectomy to reduce the effect of faciocervical appearance.Methods 18 patients with benign parotid gland tumor were adopted in this study（13 cases with pleomorphic adenoma,4 cases with Warthin tumor,1 case with cyst of parotid gland）.A modified incision was performed downward from internal tragus,circled around auricular lobule,upward and rearward,then downward and rearward hair line of post aurem.This incision was applied to partial parotidectomy and tumorectomy preservation of facial nerve.After that,to fill the defect with partial sternocleidomastoid flap near mastoid process.Negative pressure drainage was applied for 3~5 days.Results Followed-up of 6~24 months,18 cases wounds healed well without salivary fistulae.Three patients underwent temporary facial nerve paralysis after the procedure and recovered in 3 months.Only one patient underwent frey syndrome after the operation for 5 months.No recurrence was founded.All the patients were highly satisfied with this modified incision.Conclusion The modified incision can be applied to partial parotidectomy and tumorectomy,compared to the traditional ＂S＂ incision,it can obtain better appearance.Depression and frey syndrome of operating field can be avoided better by reconstruction of sternocleidomastoid flap during the operation.