腮腺区域性切除术在腮腺良性肿瘤治疗中的临床价值

The clinical assessment of regional resection in the benign tumor of parotid gland

目的:探讨腮腺区域性切除术在腮腺良性肿瘤治疗中的临床价值。方法:回顾性分析1998-01-2017-03期间就诊于北京大学第一医院的195例腮腺良性肿瘤患者的临床资料,其中单侧189例,双侧6例,总计201侧肿瘤;行区域性切除术患者157侧,行浅叶全切术患者44侧。随访统计其治疗效果和并发症并对2种不同手术方式的结果进行比较。结果:共195例(201侧)肿瘤患者,术后复发4侧,暂时性的面瘫44侧,永久性的面瘫13侧,耳垂麻木80侧,面部麻木49侧,局部术区凹陷44侧,术区积液26侧,腮瘘2侧,Frey征55侧。2组之间(区域性切除术组和浅叶全切术组)在术后复发、暂时性的面瘫、永久性的面瘫、耳垂麻木、面部麻木、术区凹陷等并发症方面差异无统计学意义(P>0.05);Frey征发生率差异有统计学意义(22.3%、45.5%,P<0.05);2组术区积液和腮瘘的发生率差异有统计学意义(16.6%、4.5%,P<0.05)。进一步分析显示,手术切除方式、肿瘤位置是术区积液的独立危险因素。结论:腮腺区域性切除术创伤小,在多数并发症中与腮腺浅叶全切效果一致,且在预防Frey征发生中具有一定优势,但由于其保留了较多的腮腺组织,保留了一定的腮腺功能,虽然并没有增加腮瘘的发生率,但术后术区积液的发生率明显高于腮腺浅叶全切术,若处理不及时,仍有很大的腮瘘风险。

Objective：To evaluate the clinical assessment of regional resection and superficial lobe total resection in the treatment of benign tumors of the parotid gland.Method：One hundred and nighty-five patients operated in the First Hospital of Peking University from January 1998 to March 2017 with benign tumor of the parotid gland were retrospectively analyzed.There were 189 patients with single side tumor and 6 patients with bilateral sides,157 cases underwent regional resection and the other 44 cases underwent superficial lobe total resection.All the results and complications were recorded and analyzed between the two groups.Result：There were total 195 patients with 201 cases.All the complications were as follows,4 cases with recurrence,44 cases with temporal facial paralysis,13 cases with permanent facial paralysis,80 cases with earlobe numbness,49 cases with facial numbness,44 cases with skin retraction,26 cases with operated region effusion,2 cases with sialosyrinx,55 cases with Frey syndrome.There were no significant differences between the two groups in the incidences of recurrence,temporal facial paralysis,permanent facial paralysis,earlobe numbness,facial numbness,skin retraction.The incidence of Frey syndrome in the superficial lobe total resection group was significantly higher than the regional resection group（45.5%,22.3%,P〈0.05）.The incidence of operated region effusion or sialosyrinx in the regional resection group was significantly higher than the superficial lobe total resection group（16.6%,4.5%,P〈0.05）,further analysis showed that the operation method and the location of the tumor were the independent risk factors.Conclusion：Regional resection in the parotid gland tumor was less invasive,the incidences in the most complications were in consistent with superficial lobe total resection,and it was helpful in preventing the occurrence of Frey syndrome.Although regional resection conserved more parotid gland tissue so that the more conserved gland function and it also didn＇t increase the incidence of sialosyrinx,the operated region effusion was significantly increased.If the operated region effusion was not discovered and handled,there would be a risk of sialosyrinx.