内镜辅助下腮腺浅叶部分切除术与传统腮腺浅叶部分切除术的比较研究

目的 评价内镜辅助下腮腺浅叶部分切除术的可行性.方法 38例腮腺浅叶良性肿物患者接受传统腮腺手术(20例)及内镜辅助下腮腺部分切除术(18例).内镜辅助下腮腺手术切口分别采用下颌角后下(第1切口)和耳垂后上(第2切口)两小切口,各长约2～2.5 cm,采用面神经下颌缘支逆行解剖法施行手术.结果 38例腮腺良性肿瘤均完整切除,内镜组手术时间与传统腮腺手术相比差异无统计学意义(P>0.05),手术出血量小于传统腮腺手术出血量(P<0.01).内镜组18例患者术后均对面容满意,其中12例(66.6%)术后对于耳大神经保护满意,1例发生暂时性轻微口角偏斜,1个月后恢复;1例发生积涎腺液,再加压2周后恢复.术后两组随访24～50个月(平均39个月),无肿瘤复发.结论 内镜辅助下腮腺浅叶部分切除术适用于腮腺浅叶良性肿物的手术治疗,该术式有助于改善患者术后面容.

A comparison of endoscopy-assisted and conventional partial-superficial parotidectomy

Objective To investigate the feasibility of endoscopy-assisted partial-superficial parotidectomy. Methods 38 cases with benign tumors located in the superficial lobe of the parotid gland were randomly assigned to receive conventional (20 cases) or endoscopic (18 cases) partial-superficial paretidectomy. Two short incisions, which were 2 ～ 2.5 cm in length and located at retromandibular and postauricular area, were adopted for endoscopy-assisted surgery. The facial nerve was dissected through retrograde approach. Results The tumors were successfidly resected with endoscopy in 18 cases. The operation time was not significantly different between the conventional and endoscopy-assisted procedures (P > 0.05). The intraoperative blood loss was markedly lower in endoscopy-assisted group, compared with conventional group(P < 0.01). All the 18 cases with endoscopy-assisted surgery were satisfactory with the postoperative cosmetic results. The great auricular nerve was preserved very well in 12 patients(66.6%). Transcient facial paralysis happened in 1 ease and relieved 1 months later. Salivary fistula occurred in 1 case and recovered after dressing with pressure for 2 weeks. All the patients were followed up for 24 ～ 50 months (mean, 39 months) without relapse. Conclusions Endoscopy-assisted partial-superficial parotidectomy can successfully treat benign tumors located in the superficial lobe of parotid gland with a better postoperative cosmetic result.