腮腺区广泛型复发性多形性腺瘤的面神经处理及术后放疗经验:附10例报告

Experience of facial nerve management and postoperative radiotherapy in general recurrent pleomorphic adenoma of parotid gland:report of 10 consecutive cases

目的:总结腮腺区广泛型复发性多形性腺瘤的面神经处理及术后放疗的相关经验。方法:对收集的10例腮腺区广泛型复发性多形性腺瘤患者的临床特征进行分析,重点分析术中面神经处理方法及术后放疗的作用。结果:10例患者中,男6例,女4例;年龄23~51岁,平均38岁(中位年龄37岁)。10例患者均具有多次术后复发特点,其中6例首次术式为局麻下肿瘤结节摘除术。所有患者均接受手术治疗,术式为腮腺全叶切除术结合术中具体情况处理面神经(完整保留5例、端-端吻合2例、耳大神经桥接2例、咬肌神经转位修复1例)。所有患者均接受术后放疗,放疗剂量为55~62 Gy/25~30 Fx,随访至今未见肿瘤复发。结论:腮腺区广泛型复发性多形性腺瘤有多次复发、侵袭性强等特点,手术应注意在彻底切除肿瘤的同时,尽可能保护面神经。无法保留完整性时,则切除受累段、同期修复重建,辅助放疗可能对提高局部控制率有一定帮助。

PURPOSE: To preliminarily summarize the experience of facial nerve management and postoperative radiotherapy in general recurrent pleomorphic adenoma of parotid gland. METHODS: The clinical features of general recurrent pleomorphic adenoma of parotid gland were reviewed and analyzed, with emphasis on facial nerve management and post-operative radiotherapy. RESULTS: A total of 10 cases(6 males and 4 females) of general recurrent pleomorphic adenoma of parotid gland were collected. The age ranged from 23-51 years(mean: 38, median: 37). All patients suffered from multi-ple-recurred lesions. The initial management of 6 patients were removal of the tumor nodule under local anesthesia. Total parotidectomy plus facial nerve management based on specific situation(complete preservation in 5 cases, side-to-side anastomosis in 2 cases, great auricular nerve abridgement in 2 cases and masseter nerve transposition in 1 case) were performed. All the ten cases received adjuvant radiotherapy(dose: 55-62 Gy/25-30 Fx), and no tumor recurrence hap-pened to date. CONCLUSIONS: The general recurrent pleomorphic adenoma of parotid gland may relapse repeatedly and invade widely. Surgery should be performed to remove the tumor thoroughly and protect the facial nerve as much as possible, and adjuvant radiotherapy may be beneficial to improve local control rate.