V形隐蔽切口在腮腺良性肿瘤手术中的应用价值

Clinical value of V-shaped concealed incision in parotid benign tumors

目的:探讨V形隐蔽切口在腮腺良性肿瘤手术中的应用价值。方法:选取2016-01-2017-12期间住院治疗的32例腮腺良性肿瘤患者,均始于耳屏前皮纹,向下达耳垂,顺耳垂向后延伸到耳后沟,即形成一个以耳垂为交点的V形切口入路行腮腺良性肿瘤及浅叶切除、面神经解剖术,术中尽量保留耳大神经及腮腺咬肌筋膜,并对术后切口隐蔽情况和手术预后进行1年的随访观察。结果:①所有患者均达到Ⅰ期愈合,无涎瘘和感染发生;32例患者术后美观满意度的视觉模拟量表(VAS)评分均为0分。②术后2例出现暂时性面瘫,分别于第1、2个月后恢复正常,其余患者未出现面神经麻痹症状;③32例患者均保留了耳大神经耳后、耳下支,术后出现不同程度的耳垂麻木感,3个月后感觉基本完全恢复;④2例患者术后咀嚼运动时出现患侧颊部皮肤潮红及出汗,其余患者无明显Frey综合征出现;⑤5例术中用胸锁乳突肌瓣修复的患者术后1年复查,术侧与健侧相比,无明显不对称性凹陷;⑥术后随访1年,32例患者均无复发。结论:V形隐蔽切口行腮腺良性肿瘤切除术,切口入路隐蔽、瘢痕不明显,术中术野暴露清晰,操作方便,不易损伤面神经、耳大神经,术后患者有较满意的面部外形,腮腺分泌功能基本正常,较传统S形切口有优越性,具有较好的临床应用价值。

Objective:The aim of this study is to explore the clinical value of V-shaped concealed incision in parotid benign tumors surgery.Method:Thirty-two patients with benign parotid tumors who were hospitalized from January 2016 to December 2017 were selected.All patients were treated with a V-shaped incision approach,starting from the anterior dermatoglyph of the tragus,extending downward to the earlobe and backward to the posterior earlobe,which formed an intersection point of the earlobe for parotid benign tumors,superficial lobectomy and facial nerve dissection.The greater auricular nerve and parotid masseter fascia were preserved,and the occult incision and prognosis were followed up for 1 year.Result:①All patients achieved primary healing without salivary fistula and infection.The visual analogue scale(VAS)score of 32 patients with postoperative aesthetic satisfaction was 0.②Of the 32 patients,only 2 had temporary facial paralysis after operation,which returned to normal after 1 and 2 months,while the rest had no facial paralysis symptoms.③The posterior and inferior auricular branches of the greater auricular nerve were preserved in all the 32 patients,and the sensation of the lobe was numb to varying degrees after the operation.After 3 months,the sensation recovered completely.④Two patients had skin flushing and sweating on the affected cheek during masticatory exercise,while the others had no Frey syndrome.⑤Five patients who were repaired with sternocleidomastoid muscle flaps during operation were reexamined one year after operation.There was no significant asymmetric depression on the operative side compared with the healthy side.⑥All the 32 patients were followed up for 1 year without recurrence.Conclusion:The V-shaped concealed incision is performed for benign tumor resection of the parotid gland.The incision approach is concealed and the scar is not obvious.The surgical field is clear and easy to operate.It is not easy to damage the facial nerve and the ear nerve.After the operation,the patient has a satisfactory facial shape.The parotid gland secretion function is basically normal,which is superior to the traditional S-shaped incision and has good clinical application value.