内镜辅助经口入路颌下腺切除的初步经验

Preliminary experience with endoscope-assisted transorul excision of the submandibular gland

目的探讨内镜辅助经口入路颌下腺切除术的指征和利弊。方法回顾性分析12例内镜辅助经口入路颌下腺切除术患者的临床资料。术前诊断慢性颌下腺炎8例（2例含涎石），多形性腺瘤3例，颌下腺囊肿1例。所有病例术前经影像学评估，其中8例经细针穿刺细胞学或细针穿刺组织学活检确诊。结果术后2例出现暂时性的舌体麻木和舌体运动障碍，1～3个月后完全缓解；无其他并发症。术后1个月未损害面容满意度采用视觉模拟量表评分均为10分，所有患者都满意。多形性腺瘤患者随访时间12～48个月（中位数36个月），未见复发。结论内镜辅助经口入路良性颌下腺病损切除术安全、可行，优点是无颈部瘢痕和面神经下颌缘支损伤的风险。

Objective To discuss the indications, risks and benefits of endoscope-assisted transoral approach to excise the submandibular gland. Methods A retrospective review of a series of 12 patients treated by endoscope-assisted transoral submandibular gland excision was carried out. Of the 12 patients, 8 were chronic sialoadenitis （2 cases with sialolith ）, 3 were pleomorphic adenoma, and 1 was cyst of submandibular gland. Preoperatively, all patients were diagnosed as benign diseases by Ultrasonography, CT or MRI. Pathologic diagnosis of 8 cases were identified by fineneedleaspiration cytology （FNAC） or fineneedle aspiration biopsy （FNAB）. Results Temporary lingual sensory paresis and temporary limitation of tongue movement were found in two patients. However, these signs soon resolved spontaneously within 1 - 3 months. There were no other complications. Postoperatively, mean satisfaction score with cosmetic results was 10. All patients were satisfied with the cosmetic results. No recurrences were found in patients with pleomorphic adenoma with a follow-up period ranged from 12 months to 48 months（ median follow-up period： 36 months）. Conclusions Endoscope-assisted transoral excision of the submandibular gland is a feasible and safe approach for the benign diseases of the submandibular gland . The major advantages of this approach are no external scar and no injury to the marginal mandibular nerve.