肿瘤发生相关的腮腺体表分区的临床解剖

Clinical anatomy of parotid surface division associated with tumorigenesis

目的基于腮腺的解剖学和肿瘤影像学资料对人体腮腺进行体表解剖分区。方法基于腮腺肿瘤的CT影像学资料,本研究提出了腮腺解剖分区的方法,以鼻翼、口角、耳垂以及下颌支后缘等体表标志点,确定A、B两条线,将腮腺分为Ⅰ、Ⅱ及Ⅲ区。解剖观察腮腺区结构,并对影像学上腮腺肿瘤的发生部位进行分区分析。结果腮腺Ⅰ区内主要包括面神经分支、耳大神经、颈外静脉及下颌后静脉,Ⅱ区内主要包括面神经分支以及面横动脉,Ⅲ区内主要包括耳颞神经以及颞浅动、静脉。对照分析影像学资料,可以发现在不跨区生长的肿瘤中,Ⅰ区肿瘤的发生率较高(38.89%),肿瘤跨区生长不会发生在Ⅰ区/Ⅱ区内,发生跨区生长的肿瘤大部分为直径较大的肿瘤,其中62.5%肿瘤直径大于3 cm。结论本研究提出的腮腺解剖分区的方法,具有一定的解剖学和肿瘤生物学价值,可为腮腺肿瘤的临床手术治疗提供参考。

Objective To partition human parotid gland on the body surface anatomically based on radiological images of parotid tumors. Methods According to parotid tumors computed tomography（ CT） images,the method of partitioning parotid gland was proposed in this study. Line A and B were determined by the several landmarks such as alae nasi,angle of mouth,earlobe and posterior margin of mandibular ramus,which partitioned parotid gland into regions Ⅰ,Ⅱ and Ⅲ. Parotid regions were dissected and observed in cadavers. Regions of tumors shown in parotid CT images were analyzed according to the partition method. Results Branches of facial nerve,great auricular nerve,external jugular vein and retromandibular vein appeared frequently in region Ⅰ of parotid gland. Branches of facial nerve and transverse facial artery appeared frequently in region Ⅱ. Auriculotemporal nerve and superficial temporal artery and vein appeared frequently in region Ⅲ. Based on analyzing the CT images of parotid glands,it could be concluded that tumor incidence in region Ⅰ is the highest rate among the tumors which grew in only one region,that no tumor grew in both region Ⅰ and region Ⅱ,and that the tumors which grew in both two regions are those who have relative large volume,among which62. 5% tumors have larger than 3 cm diameters. Conclusion The method of partitioning parotid gland anatomically has the value of anatomy and tumor biology based on this research,which could be valuable for parotid tumor resection clinically.