耳周V形切口在腮腺区良恶性病变手术中的应用

Application of periauricular V-shaped incision in the operation of benign and malignant le⁃sions in parotid region

目的:探讨耳周V形切口在腮腺区良恶性病变手术中应用的可行性。方法:回顾性分析2019年3月至2021年9月因腮腺区病变接受手术治疗且均行耳周V形切口的患者43例(44侧),其中先天性疾病4例、炎性疾病3例、良性肿瘤31例、恶性肿瘤5例;按腮腺切除范围分为区域性腮腺切除组、腮腺腺叶切除组及全腮腺切除组3组;观察并记录患者手术情况、住院时间、术后并发症及瘢痕情况等。结果:3组手术时间、引流量比较,差异有统计学意义(P<0.05),3组引流时间及住院时间比较,差异无统计学意义(P>0.05);43例患者均无味觉出汗综合征的发生,唾液瘘2例,耳垂麻木15例,暂时性面瘫14例(术后8~12周均可恢复正常);3组暂时性面瘫及耳垂麻木比较,差异均有统计学意义(均P<0.05),以全腮腺切除组的发生率最高,分别达到100%和83.3%;3组瘢痕评分比较差异无统计学意义(P>0.05)。结论:耳周V形切口入路对腮腺区良、恶性病变可达到完整切除的同时,能最大限度的顾及美容效果;在对术前、术中评估有良好把握的前提下,该切口对未发生淋巴结转移的腮腺中低度恶性病变的手术应用具有可行性。

Objective:To investigate the feasibility of periauricular V-shaped incision operation of benign and malignant lesions in parotid region.Methods:A retrospective analysis was performed on 43 patients(44 sides)(including 4 cases of congenital disease,3 cases of inflammatory disease,31 cases of benign tumor and 5 cases of malignant tumor)who underwent periauricular V-shaped incision for parotid lesions from March 2019 to September 2021.According to the scope of parotidectomy,they were divided into regional parotidectomy group,parotid gland lobectomy group and total parotidectomy group.The operation,hospital stay,postoperative complications and scar were observed and recorded.Results:There were significant differences in operation time and drainage volume among the three groups(P<0.05).There were no significant differences in drainage time and hospital days among the three groups(P>0.05).All the 43 patients had no occurrence of gustatory sweating syndrome,there were 2 cases of salivary fistula,15 cases of earlobe numbness and 14 cases of temporary facial paralysis(all returned to normal 8 to 12 weeks after operation).There were significant differences in temporary facial paralysis and earlobe numbness among the three groups(P<0.05).The incidence rate of total parotidectomy group was the highest,reaching 100%and 83.3%respectively.There were no significant differences in scar score among the three groups(P>0.05).Conclusion:The peri-auricular V-shaped incision approach can achieve complete resection of benign and malignant lesions in the parotid region with maximum aesthetic effect.On the premise of good preoperative and intraoperative evaluation,this incision is feasible in the surgery of low-and medium-grade parotid lesions without lymph node metastasis.