颌下腺瓣修复腮腺深叶肿物切除后缺损的临床观察

Use of submandibular gland flap for the repir of defect after resection of large benign tumors in deep lobe of parotid gland

目的观察采用颌下腺瓣转移修复腮腺深叶巨大良性肿瘤切除术后缺损的临床疗效,并与胸锁乳突肌瓣转移修复术比较。方法选取2012年1月至2017年12月行手术治疗的腮腺深叶良性肿瘤患者44例,按照随机数字表法随机分为经颌下入路组和腮腺入路组,每组22例。腮腺入路组采用改良Blair切口联合胸锁乳突肌瓣填塞肿瘤切除术后间隙区,颌下入路组采用经颌下入路联合颌下腺皮瓣填塞肿瘤切除术后间隙区。比较两组患者的手术时间、术中出血量、住院时间及面神经等手术并发症。结果两组患者均完整切除肿瘤,术后颅面部均无明显畸形。颌下入路组手术时间、术中出血量分别为(211±57)min、(394±127)ml,与腮腺入路组的(282±37)min、(763±205)ml比较,差异均有统计学意义(P<0.05)。颌下入路组面神经损伤4.5%(1/22)、Frey综合征4.5%(1/22)、术后口干的发生率13.6%(3/22),未发现深部创口感染、皮瓣坏死病例;腮腺入路组面神经损伤13.6%(3/22),术后深部创口感染13.6%(3/22),皮瓣坏死发生率4.5%(1/22),上述并发症的发生率差异均无统计学意义。结论采用颌下入路联合颌下腺瓣修复腮腺深叶良性肿瘤切除后缺损手术时间短、术中出血量少,临床效果好。

Objective To evaluate the clinical results of submandibular gland flap for the repir of defect after resection of large benign tumors in deep lobe of parotid gland.Methods Forty-four patients with deep parotid benign tumors were randomly divided into submandibular gland flap and sternocleidomastoid muscle flap group.Tumors were excised and the defects filled up by submandibular gland flap or sternocleidomastoid muscle flap.The results were evaluated and compared.Results There were no significantly differences in facial nerve complications,postoperative infection rate,flap survival rate and Frey syndrome between the two groups(P>0.05).The operation time and intraoperative blood loss in submandibular gland flap were significantly lower than those in sternocleidomastoid muscle flap(P<0.05).Conclusions The method of submaxillary approach combined with submaxillary gland flap to repair the defect after resection of parotid deep lobe benign tumor has the advantages of short operation time,less bleeding during operation and good clinical effect.