腮腺多形性腺瘤187例临床分析

目的 探讨腮腺多形性腺瘤的临床诊断、手术方式的选择及术后复发和并发症的防治。方法 对187例腮腺多形性腺瘤手术病例的临床资料进行分析，其中包膜外肿瘤切除+周围部分腮腺组织切除术86例，保留面神经的肿瘤切除+腮腺次全切除术72例，保留面神经的肿瘤切除+腮腺全切除术29例。结果 术后肿瘤复发12例，经二次手术无再复发。术后发生暂时性面瘫20例，其中颊支面瘫6例，下颌缘支面瘫10例，颧支、颊支、下颌缘支面瘫者4例，经激素、神经营养药、中医理疗等处理，面神经麻痹超过6个月且不能完全恢复者为永久性面瘫。本组永久性面瘫2例；出现涎瘘15例，Frey综合征36例。结论 腮腺多形性腺瘤的最后确诊必须依赖病理检查，以包膜外切除整个肿瘤，术中冰冻切片最为妥当，其手术方式的选择应根据肿瘤的大小、位置、与面神经的关系等来决定，术中面神经解剖是手术的关键，既能有效控制肿瘤的复发又能尽量避免并发症是手术的要点。

Clinical analysis of parotid pleomorphic adenoma in 187 cases

Objective To explore the clinical diagnosis and surgical method for parotid pleomorphic adenoma, as well as the prevention and therapy of postoperative recurrence and complications. Methods Clinical data of 187 parotid pleomorphic adenoma cases were collected and analyzed, including 86 cases of partial parotidectomy (extra capsular resection of tumor), 72 case of subtotal parotidectomy with facial nerve preservation, and 29 cases of total parotidectomy with facial nerve preservation. Results After operation, 12 patients relapsed. No relapse occurred after the second operation. There were 20 transient facial nerve paralysis, 6 buccal branch′s facial paralysis, 10 marginal mandible branch′s facial paralysis, and 4 intermix facial paralysis. Treated with hormones, neurotrophy, and traditional Chinese physical medications, permanent facial nerve paralysis only remained in 2 cases, which lasted more than 6 months without complete recovery. In addition, parotid fistula appeared in 15 cases, and Frey′s syndromes were found in 36 cases. Conclusions The final diagnosis of parotid pleomorphic adenoma must rely on pathological examination. The best strategy is extracapsular resection combined with frozen pathology during the operation. The surgical method to remove the parotid pleomorphic adenoma should be chosen according to the size and position of the tumor, and the relationship between the tumor and facial nerve. The key point of surgery is anatomy of facial nerve, which can reduce the postoperative recurrence and complications.