两种保留SMAS术式对腮腺肿瘤术后复发和预防Frey综合征的对比研究

Comparison of the effects of two types of SMAS reservations on tumor recurrence and Frey's syndrome prevention after parotidectomy

目的:评价在腮腺肿瘤切除术中两种保留面部表浅肌肉腱膜系统(Superficial musculoaponeurotic system,SMAS)术式对味觉出汗综合征的预防效果和对腮腺肿瘤术后复发的影响。方法:125例良性腮腺肿瘤患者随机分为3组。Ⅰ组(游离保留SMAS法)39例,Ⅱ组(非游离保留SMAS法)46例,Ⅲ组(按传统手术方法未保留SMAS)40例。术后6～12个月,所有患者均通过调查问卷形式和碘-淀粉试验对味觉出汗综合征分别进行主观评价和客观评价。所有患者均完成了术后2～3年对肿瘤复发情况的随访。结果:Ⅰ、Ⅱ组和Ⅲ组味觉出汗综合征的主观评价发生率分别为5.1%(2/39)、26.1%(12/46)和55.0%(22/40)(P<0.05);客观评价发生率分别为10.3%(4/39)、37.0%(17/46)和72.5%(29/40)(P<0.05)。术后经2～3年的随访,3组患者共125例均无复发病例。结论:保留SMAS是预防腮腺肿瘤术后发生味觉出汗综合征的有效方法,但游离保留SMAS法疗效更佳。保留SMAS不会增加良性腮腺肿瘤的复发。

Objective：To evaluate the effects of two types of superficial musculoaponeurotic system（SMAS） reservations on the prevention of Frey＇s syndrome and tumor recurrence after parotidectomy.Methods：125 patients suffering from benign tumors of parotid gland were divided randomly into three groups（Ⅰ～Ⅲ groups）：groupⅠ：Parotidectomy with free SMAS reservation in 39 cases;groupsⅡ：Parotidectomy with non-free SMAS reservation in 46 cases;groups Ⅲ：Parotidectomy without SMAS reservation in 40 cases.After operation 6 to 12 months,all the 125 patients were evaluated for gustatory sweating by both questionnaire and minor starch-iodine test.All the patients were followed up for tumor recurrence after operation 2 to 3 years.Results：Subjective evaluation of Frey＇s syndrome revealed that the incidence rates of Ⅰgroup,Ⅱgroup and Ⅲ group were 5.1%（2/39）,26.1%（12/46） and 55.0%（22/40） respectively（P〈0.05）.Objective evaluation of Frey＇s syndrome revealed that the incidence rates of Ⅰgroup,Ⅱgroup and Ⅲ group were 10.3%（4/39）,37.0%（17/46） and 72.5%（29/40） respectively（P〈0.05）.There was not tumor recurrence case in all 125 patients.Conclusion：Reservation of SMAS is an effective method for prevention of Frey＇s syndrome after parotidectomy.The incidence rate of free SMAS reservation is lower than that of non-free SMAS reservation.Reservation of SMAS does not increase recurrence rate of benign parotid tumor.