面神经中段解剖法在区域性腮腺切除术中的应用

Clinical application of midpiece facial nerve dissection in regional parotidectomy

目的提出经腮腺实质内面神经中段解剖法并评价其在区域性腮腺切除术中的应用效果。方法回顾性统计了自2016年1月至2017年12月行腮腺良性肿瘤手术患者136例,按照面神经解剖方法分类,分为顺行总干解剖法(顺行组,70例)、逆行分支解剖法(逆行组,34例)、实质内中段解剖法(中段组,32例),比较3组的手术时间,面神经损伤和耳垂感觉状况,涎瘘、Frey’s综合征发生率,并进行美学评价。结果中段组手术时间较其他两组明显缩短(P<0.05);中段组术后未出现涎瘘患者,顺行组涎瘘发生的比例较高(9例,12.9%)(P<0.05);中段组和顺行组术后面神经损伤率均较低(顺行组3例,4.3%;中段组1例,3.1%),逆行组面神经损伤比例偏高(7例,20.6%)(P<0.05);中段组和逆行组均未出现耳垂感觉减退情况,而顺行组出现比例较高(12例,17.1%)(P<0.05);术后中段组及顺行组患者对术后面部外形比较满意,而逆行组对美观评价一般(P<0.05)。结论面神经中段解剖法在技术上是可以实行的,在腮腺良性肿瘤的区域性切除术中,可以取得较好的临床效果,具有一定的临床应用价值。

Objective To propose and evaluate the clinical effect of midpiece facial nerve dissection through transparotid approach in regional parotidectomy.Methods A total of 136 patients with benign parotid tumors were categorized into three groups according to the way of facial nerve dissection:anterograde dissection from main trunk(anterograde,n=70),retrograde dissection from distal branches(retrograde,n=34),and midpiece dissection through transparotid approach(middle dissection,n=32).Surgery duration,facial nerve injury,salivary fistula,earlobe sensation,Frey’s syndrome,and aesthetic evaluation were compared.Results The surgery duration in the middle dissection group was significantly shorter than that in the other two groups.The proportion of salivary fistula was higher in the anterograde group(9 cases,12.9%;P<0.05)compared with that in the other groups.Postoperative facial nerve injury was similar between the middle dissection(1 case,3.1%)and anterograde groups(3 cases,4.3%)with lower injury rate compared with the retrograde group(7 cases,20.6%).The anterograde group had more cases of hypoesthesia of the earlobe(12 cases,17.1%;P<0.05)than the other two groups.Aesthetic score was higher in the anterograde and middle dissection groups compared with that in the retrograde group(P<0.05).Conclusion Midpiece facial nerve dissection is technically feasible and clinically viable in regional parotidectomy.