腮腺区面神经鞘瘤临床特点及外科治疗的回顾性分析

Retrospective analysis of clinical features and treatment of intraparotid facial nerve schwannoma

目的总结分析原发于腮腺区面神经鞘瘤的临床特点、手术策略及预后。方法收集1994年6月至2019年6月常州市第一人民医院口腔颌面外科收治的17例原发于腮腺区面神经鞘瘤临床资料。包括年龄、性别、术前影像学诊断、治疗方式、肿瘤与面神经的关系以及面神经功能受损情况,采用SPSS 17.0软件Fisher精确检验。结果术前3例患者有面瘫、刺痛等神经症状,占比17.65%(3/17)。通过B超、CT、MRI、细针吸取细胞学检查(FNAC)等评估,术前确诊率为35.29%(6/17)。1例患者肿瘤与神经粘连无法分离,肿瘤与面神经一并切除后同期行面神经移植,其他16例患者分别接受剥离切除术或囊内摘除术。术后有不同程度的面神经损伤,占比58.82%(10/17)。随访1年以上进行面神经功能复查,3例患者神经损伤症状消失,7例患者神经受损情况不同程度改善。病灶剥离术总有效率为28.57%(2/7),囊内摘除术总有效率为88.89%(8/9),差异有统计学意义(P<0.05)。17例患者平均随访12~220个月,未见肿瘤复发或恶变。结论原发于腮腺区的面神经鞘瘤比较少见,术前诊断较难,确诊需术中快速(或术后常规)病理。该肿瘤治疗方案以手术为主,囊内摘除术能最大程度保护面神经,是腮腺区面神经鞘瘤的最佳手术方案。

Objective To investigate the clinical features,diagnosis,surgical management as well as the prognosis of intraparotid facial nerve schwannoma.Methods Seventeen cases of intraparotid facial nerve schwannoma from June 1994 to June 2019 were collected from the First People’s Hospital of Changzhou in Oral and Maxillofacial Surgery Department,information on their age,sex,imaging examination,treatment,relationship between tumor and facial nerve,and impairment of facial nerve function was included.SPSS17.0 software package was used for Fisher’s exact test.Results Three patients(17.6%)had facial paralysis or other neural symptoms and 6 patients(35.29%)were diagnosed by B ultrasound,CT,MRI or FNAC(fine needle aspiration cytology examination)before operation.In one case,nerve grafting was performed after nerve transection because it was impossible to separate the facial nerve from the tumor during the operation.In other 16 cases,stripping surgery and intracapsular enucleation surgery were performed respectively.10 cases(58.82%)had symptoms of facial nerve impairment postoperatively.Symptoms of nerve injury disappeared in 3 patients,and improved in 7 patients after follow-up for more than one year.The effective rate of preserving facial function was 28.57%(2/7)in stripping surgery group,and the rate was 88.89%(8/9)in intracapsular enucleation surgery group.All patients were followed up for 12 months to 220 months,and no recurrence and malignant transformation were found.Conclusion Intraparotid facial nerve schwannoma is rare.The diagnosis of schwannoma in parotid region is difficult and needs to be confirmed by pathology.Intracapsular enucleation surgery can protect facial nerve to the greatest extent and is the best surgical scheme for intraparotid facial nerve schwannoma.