内镜辅助经下颌下入路腮腺深叶多形性腺瘤切除术

摘要：目的探讨内镜辅助经下颌下入路切除腮腺深叶多形性腺瘤的可行性及疗效。方法采用内镜辅助经下颌下入路切除腮腺深叶多形性腺瘤7例,其中男2例,女5例,年龄36～65岁,平均年龄47岁。主要症状是吞咽异物感5例,咀嚼不适感2例;主要体征为发现患侧咽侧壁、软腭部膨隆6例,另1例无明显阳性体征。结果本组7例手术均在1.5～2.5 h内顺利完成,肿瘤获得完全切除,切口甲级愈合。且无腮腺区肿胀、声嘶、呛咳、呼吸及吞咽困难、伸舌偏斜发生,其中1例术后2 d出现患侧口角歪斜,约1个月后完全恢复。术后病理均为多形性腺瘤。随访时间6～38个月,平均为20个月。结论内镜辅助经下颌下入路可以完全、彻底切除腮腺深叶多形性腺瘤,既能保留面神经功能,又有助于同时保护颈部重要血管、神经,值得临床推广应用。     

腮腺多形性腺瘤28例术后分析

我院自 1 986～ 1 997年共收治腮腺多形性腺瘤2 8例 ,均手术治疗 ,现报告如下。1 　 资料与方法2 8例中 ,男 1 0例 ,女 1 8例 ;年龄 2 2 65岁 ,平均3 9岁。左侧 1 6例 ,右侧 1 2例。腺瘤位于腮腺浅叶者 2 7例 ,位于腮腺深叶者 1例 ,术前均无面神经功能障碍。1 986～ 1 992年 ,采用单纯多形性腺瘤摘除术 6例 ;1 993 1 997年采用经典的保留面神经的腮腺切除术 2 2例 ,其中多形性腺瘤加腮腺浅叶切除术 2 1例 ,多形性腺瘤加腮腺全切除术 1例 ,术中均转移胸锁乳突肌肌瓣覆盖面神经和耳颞神经 ,术中保留腮腺主导管者 1 2例。2 　 结果采用单纯多形…     

腮腺多形性腺瘤癌变的病理学观察

５４４例腮腺我形性腺瘤中,恶性１８例,占３．３％,其中癌变１６例,原发性恶性多形性腺瘤２例。除细胞间变外,具有肿瘤的侵袭性及快速增殖的特征：包膜浸润、侵犯邻近组织、血管内瘤栓、核分裂象增多等对诊断更有意义。在５２６例良性瘤中女性多见,计有３１５例,占５９．８％。年龄多为２０～５２岁;而此瘤伴癌变者１６例中以男性居多１１例,占６８．８％,常见于５０岁以上。组织学类型,示分化癌居多,占４３．７％,而腺     

腮腺部分切除术治疗腮腺多形性腺瘤的临床观察

目的 比较腮腺多形性腺瘤区域性切除术与浅叶切除术两种术式的术后复发率及并发症发生情况,为临床合理选择术式提供依据.方法 总结2002年1月～2008年6月间收治的腮腺多形性腺瘤81例,其中51例采用腮腺区域性切除术,30例行腮腺浅叶切除术,随访时间3～9年.结果 采用腮腺区域性切除手术的病例术后面瘫、Frey综合征、涎瘘的发生率均低于腮腺浅叶切除术,而肿瘤的复发率无明显差异.结论 区域性切除术手术创伤小,并发症少,还可以保存腮腺一定的功能,可作为腮腺多形性腺瘤临床治疗的首选术式.     

内镜经鼻蝶扩大入路手术治疗鞍结节脑膜瘤

目的探讨内镜下经鼻蝶扩大入路切除鞍结节脑膜瘤的可行性、手术技巧及并发症的防治。方法回顾性分析19例内镜下经鼻蝶扩大入路鞍结节脑膜瘤切除患者临床资料、手术疗效、并发症、长期随访结果。结果19例中9例实现Simposon I级切除,8例II级切除,2例III级切除。6例头痛均好转,16例视力视野损害患者术后改善14例,2例发生脑脊液漏,其中1例并发颅内感染,12例出现嗅觉损害。随访4~31个月无迟发型脑脊液漏、癫痫、尿量改变、垂体功能减退等并发症。10例嗅觉损害患者术后随访12个月时均得到部分恢复。结论内镜下经鼻蝶扩大入路切除鞍结节脑膜瘤是可选的理想手术入路。     

鼻内镜经鼻腔-蝶窦入路摘除脑垂体瘤1例

病人，男，62岁，因头痛2年，加重3个月，伴间歇性视力模糊收住院。     

内镜下经口入路颌下腺切除术的临床分析

目的探讨内镜辅助经口入路颌下腺切除的有效性、安全性和可行性。方法经鼻插管全麻后,沿颌下腺导管开口至磨牙后区的下颌舌颌沟做弧形切口,内镜辅助下分别沿下颌下腺导管,切断与颌下腺有关的神经、血管、导管,将颌下腺切除。结果5例患者均顺利切除颌下腺,1例出现暂时性舌体麻木,2周后恢复。无面神经下颌缘支及舌下神经损伤,无其他并发症。颈部无瘢痕,美容效果好。结论内镜辅助下经口入路颌下腺切除术安全、可行,值得临床推广应用。     

内镜辅助耳前颞下窝入路颞下窝良性肿瘤切除术

目的探讨内镜辅助经耳前颞下窝入路切除颞下窝良性肿瘤的可行性及疗效。方法采用内镜辅助经耳前颞下窝入路切除颞下窝良性肿瘤5例,男1例,女4例;年龄41～59岁,平均51岁。主要症状是咀嚼不适感4例,患侧头痛3例,患侧听力下降2例。主要体征为患侧颞颧部膨隆3例,其余2例无明显阳性体征。结果手术均在1.5～3.0 h内顺利完成,肿瘤完全切除。患者术后感觉患侧咀嚼无力、闭合力稍差、张口受限、术区肿胀,约2个月后基本正常。随访6～26个月,平均18个月,未发生面瘫、无颞下颌关节错位咬合、无慢性疼痛等并发症,其中1例术后12个月,仍感觉患侧下颌部麻木。切口均甲级愈合。术后病理2例为巨细胞修复性肉芽肿,2例为骨巨细胞瘤,1例为磷酸盐尿性间叶组织肿瘤。所有患者随访至今均无复发。结论内镜辅助经耳前颞下窝入路可以彻底切除翼外板、翼外肌下头外侧区域颞下窝上部关节区附近的一些良性肿瘤,是安全、有效、微创的,值得临床推广应用。     

内镜经口入路咽后淋巴结切除术

目的:探索内镜经口入路咽后淋巴结切除术相关解剖和手术方法.方法:在复旦大学附属眼耳鼻喉科医院解剖实验室对3例(6侧)新鲜冰冻尸头标本进行内镜经口入路咽后间隙解剖学研究,依次显露咽上缩肌、翼内肌、腭帆张肌腱、茎突前间隙脂肪、腭升动脉及其分支、茎突舌肌、茎突咽肌、茎突舌骨肌、颈外动脉、腭帆提肌、颈动脉鞘、咽升动脉以及头长肌...     

Familial occurrence of pleomorphic adenoma

Pleomorphic adenoma is the most common neoplasm found in the parotid gland. The familial occurrence of any salivary gland neoplasm is rare. There are 8 previous reports in the literature of familial occurrence of salivary gland tumors. Two of these report the occurrence of pleomorphic adenoma of the parotid gland in siblings; all 4 patients were adults. We report here an 11-year-old male who presented with a left parotid mass and underwent parotidectomy. The mass proved to be a pleomorphic adenoma. His sister presented 9 years later at the age of 15 years with a similar mass also in the left parotid area. She underwent superficial parotidectomy which revealed the mass to be a pleomorphic adenoma. We believe these are the youngest siblings reported to date in which familial pleomorphic adenoma has occurred.     

Correlation between computed tomography imaging and histopathology in pleomorphic adenoma of parotid gland

Objective

The purpose of this study was to correlate the CT imaging features and histopathological findings of pleomorphic adenomas (PA), and also try to identify its clinical significance.

原发多中心性腮腺多形性腺瘤1例并文献复习

<正>多形性腺瘤(pleomorphic adenoma,PA)又称混合瘤(mixed tumor,MT),是腮腺最常见的良性肿瘤,约占腮腺肿瘤的60%~70%,而同侧腮腺原发多中心多形性腺瘤极为罕见。查阅大量国内外文献,鲜有关于此病的详细描述[1-3]。我科于2012年12月4日诊断1例右侧腮腺原发多中心性多形性腺瘤,现结合既往相关文献报道,对其病因、临床特点、诊断及治疗方法进行讨论,报告如下。     

Management and prognostic factors of recurrent pleomorphic adenoma of the parotid gland: personal experience and review of the literature

The aim of this study was to investigate the management and prognostic determinants of recurrent pleomorphic adenoma (RPA). A retrospective analysis was performed to examine the clinical features, the prevalence of surgical complications, and new recurrences of RPA. Tumor recurrence rate was estimated by the Kaplan–Meier method, and the prognostic value of some of the variables was tested by univariate analysis using the log rank test. The study focused on 33 patients, 18 female (54.5%) and 15 male (45.5%), aged 12–71 years (median 41). A total or extended total parotidectomy was performed in 16 cases (48.5%), a superficial parotidectomy in 10 cases (30.3%), and a local excision in 7 cases (21.2%). In ten patients (30.3%), a branch or the trunk of the facial nerve was deliberately sacrificed. Major complications included one unexpected definitive paralysis of the marginal mandibular branch of the facial nerve and 14 cases of Frey syndrome. Follow-up varied from 2 to 25 years (median 10.5 years), and there were 11 new recurrences (33.3%) within a period varying from 1 to 16 years (median 6 years). The estimated tumor recurrence rates were 14.1 ± 6.6% at 5 years, 31.4 ± 9.4% at 10 years, 43.0 ± 10.8% at 15 years, and 57.2 ± 14.8% at 20 years. Presence of a multinodular lesion and the type of intervention performed were significantly associated with a higher probability of recurrence. RPAs are prone to new recurrences, especially when multinodular and treated with a local excision. Surgical treatment should include facial nerve resection in selected cases. Follow-up for the patient’s lifetime is warranted.     

Concurrent primary Hodgkin’s lymphoma and recurrent pleomorphic adenoma of the ipsilateral parotid gland

The synchronous occurrence of two histologically different and morphologically distinct tumours in a single parotid gland is an exceptionally rare and probably coincidental event. We have recently experienced such a case initially suspected of being a recurrent pleomorphic adenoma. Superficial parotidectomy, however, revealed two separate masses. Postoperative histopathological examination diagnosed the presence of a pleomorphic adenoma with a concurrent primary parotid gland Hodgkin’s lymphoma arising from an intraglandular lymph node. The management of this case is presented along with a brief review of the literature concerning the evaluation and management of this rare entity.     

Recurrent pleomorphic adenoma of the parotid gland: a prospective histopathological and immunohistochemical study

OBJECTIVES/HYPOTHESIS: Histopathological characteristics and proliferation indices of recurrent pleomorphic adenoma were described in a series of 31 patients who were referred to the authors' clinic for revision surgery. STUDY DESIGN: Prospective series of 31 patients. METHODS: Serial sections of surgical specimen using the whole-organ sectioning technique were carried out for light microscopic examination after total parotidectomy and periparotid fat resection. The nodules were examined with special reference to localization, amount, size, histological subtypes, capsular alterations, and the amount of nodule spilling. Expression of proliferation markers (Ki67/MIB-1) according to the size and histological subtypes of the nodules was also investigated. RESULTS: Most recurrences were multinodular, and the number of nodules was much higher than expected, ranging from 1 to 157. The myxoid subtype was predominant. Eighty percent of the patients exhibited widely distributed nodules also lying outside the scar. These nodules contained only a thin pseudocapsule and often lacked complete encapsulation. The majority of multinodular recurrences of parotid pleomorphic adenoma consisted of small nodules (less than 1 mm in diameter). Smaller nodules showed similar or higher levels of proliferative activity than larger nodules. CONCLUSION: The extended multifocal distribution of tumor recurrences after insufficient resection of pleomorphic adenoma (most often after enucleation) can explain a high incidence of further recurrences. Therefore, a total parotidectomy including removal of surrounding fat tissue seems to be appropriate for the initial treatment of recurrent pleomorphic adenoma.     

Pleomorphic adenoma of the parotid gland in children

OBJECTIVE: To evaluate the presentation, imaging characteristics and treatment outcome of pleomorphic adenoma of the parotid in the pediatric population. DESIGN: Retrospective study with institutional review board approval. SETTING: Tertiary care pediatric medical center. METHODS: An extensive review of medical records with regard to presentation, imaging, histopathology, complication, recurrence and prognosis on patients 18 years or younger presenting from 1983 to 2005. RESULTS: Eleven patients (six females, five males) were identified. The most common presentation was an asymptomatic mass. Preoperative imaging was done on nine patients: MRI (N=6), CT (N=3), ultrasound (N=2), and sialogram (N=1). Initial treatments included: superficial parotidectomy (N=5), total parotidectomy (N=3), excisional biopsy followed by superficial parotidectomy (N=2), and excisional biopsy (N=1). There were two recurrences (18%); one presenting 7 months following excisional biopsy who underwent superficial parotidectomy and one occurred 3 years following total parotidectomy requiring revision parotidectomy and radiation. Other complications included: transient facial nerve paresis (N=5; 45%) and permanent weakness (N=1; 9%). The patients were followed an average of 18 months. CONCLUSIONS: Pleomorphic adenoma is one of the most common tumors of the parotid in children. The most common presentation is an asymptomatic mass. A preoperative evaluation with MRI or CT scan can be helpful in determining the extent of the lesion and surgical planning. Complete excision via superficial or total parotidectomy with preservation of facial nerve is the treatment of choice. Long-term follow up is recommended, though was difficult in a tertiary care center.     

Pleomorphic adenoma of the parotid gland: a 13-year experience of consequent management by lateral or total parotidectomy

Optimal surgical management of parotid pleomorphic adenoma is important because of a considerable risk of tumour recurrence and complications. Our series of primary surgery cases with standardised parotidectomy technique in a university hospital were evaluated. Medical records of 295 patients treated from 1987 to 1999 were reviewed, and 171 patients answered a questionnaire about long-term sequelae. Sixty-two patients reporting major complications were re-examined in the hospital. At a mean follow-up of 8 years, one patient (0.6%) re-appeared with a recurrence. Twenty-four percent left the hospital with a partial and 3% with a complete paresis. Only 5% developed a permanent partial paresis, whereas a permanent total paresis was not seen. Half of the patients indicated gustatory sweating, but treatment was required in only 6%. Other major permanent complications were not seen. Treatment of pleomorphic adenoma by standardised parotidectomy in a university hospital demonstrates favourable results with low perioperative and long-term morbidity, as well as minimal risk of tumour relapse.     

Comprehensive analysis of parotid mass: A retrospective study of 369 cases

Objective

To present the results of patients who underwent superficial or total parotidectomy because of parotid gland tumors in our tertiary care clinic.