改良腮腺良性肿瘤切除术21例报道

Technical Refinements in Surgical Treatment of Benign Parotid Tumors:Report of 21 Consecutive Cases

目的对常规腮腺良性肿瘤切除术进行改进,使切口更加隐蔽,保护耳大神经,减少Frey’s综合征的发生,同时纠正术区凹陷。方法采取改良除皱术切口,清晰显露解剖耳大神经;转移带蒂颞肌筋膜瓣充填术区缺埙,并作为屏障阻断副交感神经与节后交感神经纤维互相吻合的途径。结果21例接受改良手术的病人,皮肤切口隐藏良好,20例伤口一期愈合,随访6月～2年,无1例发生Frey’s综合征,术侧耳垂感觉完全恢复。结论改良腮腺肿瘤手术既能彻底摘除肿瘤,又可防止术后局部凹陷畸形和Frey’s综合征的发生,值得推广应用。

Objective Several refinements were undertaken in surgical resection of benign parotid tumors to produce in-conspicuous scar,to preserve the greater auricular nerve,to prevent Frey's syndrome and to correct postoperative defi-ciency.Methods A modified rhytidecomy incision was used to expose the greater auricular nerve.A pedicled temporalis myofascial flap was transplanted to fill the surgical defect and to block the anastomosis between fibers of parasympathetic nerve and sympathetic nerve as mechanical barrier.The follow up results were compared between patients treated by conventional method and modified technique.Results21patients received modified parotidectomy.The skin scars were well concealed.The wound was healed primarily in20cases.All the patients were followed up for6to24months.None of them developed Frey's syndrome.The sensation of earlobe recovered completely.Conclusions The technical refine-ments reported in this paper allows radical resection of the parotid gland and tumors with preservation of the greater au-ricular nerve and correction of the surgical deficiency.Frey's syndrome can also be prevented efficiently.It is thus worthy of wide application in routine parotidectomy