内镜辅助耳后发际入路颌下腺切除术与传统术式的对照研究

目的 与传统经颈入路比较,评价内镜辅助耳后发际入路颌下腺切除术的可行性及其利弊.方法 2009年1月至2010年1月,前瞻性对照研究28例颌下腺良性病变患者分别行两种术式的治疗结果.其中13例接受内镜辅助耳后发际入路手术,15例接受传统经颈入路手术.术前所有病例均行CT或MRI检查评估病损大小、位置、毗邻,并行细针穿刺活检明确病理.秩和检验比较两组患者的切口长度、手术时间、术中出血量、术后并发症及切口美容效果.结果 28例患者颌下腺均顺利完整切除.内镜组切口长度、手术时间与传统组比较,差异有统计学意义(Z值分别为-4.516和-3.263,P值均＜0.01);术后3个月,内镜组切口美容效果好于传统组,差异有统计学意义(Z=-4.472,P＜0.01).术后内镜组2例患者(15.4%)出现暂时性耳垂麻木、1例(7.7%)出现暂时性面神经下颌缘支麻痹,均在术后1个月缓解.所有病例随访10～24个月,中位随访18个月,未见复发.结论 对于颌下腺良性疾病,内镜辅助耳后发际入路颌下腺切除术安全、可行.与传统经颈入路比较,切口隐蔽,美容效果确切.

Abstract：

Objective To assess the feasibility,the risks and the advantages of endoscope-assisted submandibular gland resection using a retroauricular hairline incision ( RAHI) by comparing it with the conventional submandibular gland resection.Methods Twenty eight patients with benign lesions of the submandibular gland were included in the prospective clinically controlled study.Thirteen patients had endoscope-assisted resection using the RAHI approach and 15 cases had conventional transcervical approach resection.The size,location and adjacency of all lesions were evaluated by CT or MRI before surgery.The pathologic diagnoses of all cases were identified as benign diseases using fine needle aspiration biopsy.The two groups were compared for incision length,operation time,bleeding,incision cosmetic result,and complications.Results All 28 operations were successfully performed.Incision length in the endoscopic group was significantly longer than that in the trancervical group (Z =-4.516,P＜0.01),and the surgical time was longer in the endoscopic group( Z =-3.263 ,P ＜0.01) .After three months the mean subjective satisfaction score for the incision scar in the endoscopic group was significantly higher than that in the trancervical group(Z=-4.472,P＜0.01).In the endoscopic group,2 cases (15.4%) with temporary numbness of the earlobe and 1 case (7.7% ) with a temporary marginal mandibular nerve paralysis were found postoperatively.However,they recovered within 1 month.All 28 patients were disease free with a follow-up of 10 to 24 months (median of 18 months).Conclusions Endoscope-assisted submandibular gland resection via RAHI is feasible and safe for the treatment of benign submandibular gland lesions.In comparison with the transcervical approach,this method can provide better cosmetic results without significant complications.

A comparison between endoscopic-assisted submandibular gland resection via retroauricular hairline incision and conventional submandibular gland resection

Objective To assess the feasibility,the risks and the advantages of endoscope-assisted submandibular gland resection using a retroauricular hairline incision ( RAHI) by comparing it with the conventional submandibular gland resection.Methods Twenty eight patients with benign lesions of the submandibular gland were included in the prospective clinically controlled study.Thirteen patients had endoscope-assisted resection using the RAHI approach and 15 cases had conventional transcervical approach resection.The size,location and adjacency of all lesions were evaluated by CT or MRI before surgery.The pathologic diagnoses of all cases were identified as benign diseases using fine needle aspiration biopsy.The two groups were compared for incision length,operation time,bleeding,incision cosmetic result,and complications.Results All 28 operations were successfully performed.Incision length in the endoscopic group was significantly longer than that in the trancervical group (Z =-4.516,P＜0.01),and the surgical time was longer in the endoscopic group( Z =-3.263 ,P ＜0.01) .After three months the mean subjective satisfaction score for the incision scar in the endoscopic group was significantly higher than that in the trancervical group(Z=-4.472,P＜0.01).In the endoscopic group,2 cases (15.4%) with temporary numbness of the earlobe and 1 case (7.7% ) with a temporary marginal mandibular nerve paralysis were found postoperatively.However,they recovered within 1 month.All 28 patients were disease free with a follow-up of 10 to 24 months (median of 18 months).Conclusions Endoscope-assisted submandibular gland resection via RAHI is feasible and safe for the treatment of benign submandibular gland lesions.In comparison with the transcervical approach,this method can provide better cosmetic results without significant complications.