内镜辅助下腮腺手术研究进展

手术切除是腮腺肿瘤的首选治疗方法.为改善美容效果,内镜技术在腮腺手术中广泛应用,并取得良好效果,内镜辅助下腮腺手术正在成为一种新的替代治疗方法.本文就目前已经开展的内镜辅助下腮腺手术的不同手术入路、优缺点等内容做一综述.     

保留腮腺导管的腮腺浅叶部分切除术

目的总结腮腺良性肿瘤保留导管的浅叶部分切除术的效果.方法对27例腮腺良性肿瘤保留导管的浅叶部分切除术患者进行回顾分析,评价面外形改变,腮腺的分泌功能,面神经损伤情况,唾液积潴,术后复发.结果经过1年～5年的门诊复诊及随访发现,面外形无凹陷畸形,面神经无损伤,无涎瘘形成.保留的残余腺体有涎液分泌,肿瘤无复发.结论认为保留腮腺导管的良性肿瘤浅叶部分切除术是一种可行性术式并具有很好的临床价值.     

内镜辅助下腮腺手术研究进展[综述]

手术切除是腮腺肿瘤的首选治疗方法。为改善美容效果,内镜技术在腮腺手术中广泛应用,并取得良好效果,内镜辅助下腮腺手术正在成为一种新的替代治疗方法。本文就目前已经开展的内镜辅助下腮腺手术的不同手术入路、优缺点等内容做一综述。     

改良腮腺浅叶切除术治疗腮腺良性肿瘤

目的 探讨腮腺良性肿瘤切除术中保留腮腺咬肌筋膜、耳大神经和腮腺导管对降低术后并发症的作用.方法 回顾性分析56例腮腺良性肿瘤行肿瘤切除术的患者,保留腮腺咬肌筋膜、耳大神经和腮腺导管,术后予负压引流和局部加压包扎,观察并发症的发生率.结果 所有患者术后均随访,无1例复发.3例患者发生面神经损伤,均为一侧口角略歪斜,鼓腮稍...     

耳后切口内镜辅助下腮腺良性肿瘤切除术

腮腺肿瘤中约80%为良性,而且大部分位于浅叶,传统的手术方式是面神经解剖及腮腺浅叶切除,经典手术切口为围绕耳廓前后及颌下的s形切口,从耳轮脚前向下经过耳屏、耳垂,绕过耳垂到达耳后、乳突再弧形向下、向前沿上颈皮纹到达舌骨水平。     

无注气甲状腺内镜外科手术

目的 初步评价无注气的内镜甲状腺外科手术的可行性。方法 对16例甲状腺肿物的患者分别采用颈前悬吊方法和胸骨柄上方2-3 cm水平切口进行甲状腺内镜外科手术,年龄23-62岁,其中甲状腺瘤6例,结节性甲状腺肿10例。2例采用锁骨下入路,14例采用胸骨柄上小切口入路,全部内镜下完成甲状腺手术,其中甲状腺腺叶切除术8例,甲状腺次全切除术7例,峡部加双侧腺叶部分切除术1例。结果 内镜下利于显露和识别喉返神经和甲状旁腺,手术时间为1.1-4.0 h,无并发症,术后的美观效果好。结论 无注气内镜下甲状腺外科手术技术是可行和安全的,可作为甲状腺外科的一种新术式。     

腮腺部分切除术在腮腺浅叶下极良性肿瘤中的临床价值

目的探讨腮腺部分切除术在腮腺浅叶下极良性肿瘤手术中的临床应用价值。方法回顾性研究2003年5月～2008年9月我院治疗的腮腺浅叶下极良性肿瘤患者127例,其中采用腮腺部分切除术48例,采用传统的腮腺浅叶切除术79例。所有患者随访1～5年,对比其并发症的发生率及肿瘤复发情况。结果腮腺浅叶切除术组面部畸形明显,暂时性面瘫发生率为17.7%（14/79）,味觉出汗综合征（Frey综合征）发生率为44.3%（35/79）,唾液瘘发生率2.5%（2/79）。腮腺部分切除术组患者术区面部畸形较轻,暂时性面瘫发生率为4.2%（2/48,P〈0.05）,Frey综合征发生率为10.4%（5/48,P〈0.05）,本组无唾液瘘发生。两组患者随访期间均无肿瘤复发。结论腮腺部分切除术具有手术创伤小、并发症少、术后面部畸形小等优点,是腮腺浅叶下极良性肿瘤治疗的理想术式。     

腮腺浅叶部分切除联合术中冰冻活检在治疗腮腺浅叶良性肿瘤中的应用

目的　探讨腮腺浅叶部分切除联合术中冰冻活检在腮腺浅叶良性肿瘤治疗中的应用价值。方法　回顾性分析采用腮腺浅叶部分切除联合术中冰冻活检治疗腮腺浅叶良性肿瘤126例（A组）及传统腮腺全切术治疗腮腺浅叶良性肿瘤100例（B组）的临床数据,比较两组病例近期及远期手术并发症的发生率及肿瘤复发率,并分析、讨论腮腺浅叶部分切除术的方法优势及注意事项。结果　短期并发症（感觉减退发生率、短暂性面神经乏力发生率、感觉减退发生率、Frey综合征发生率）,A组与B组比较,差异有统计学意义。A组病例中有1例患者术后病理结果提示低度恶性黏液表皮样癌,术后随访2年,未见复发。其余两组患者术后随访1~2年,未见复发。结论　腮腺浅叶部分切除具有并发症发生率低,创伤小的优点,同时并不增加肿瘤复发率,联合术中冰冻活检可以避免术中漏诊恶性肿瘤,值得在腮腺浅叶良性肿瘤的手术治疗中推广。     

保留腮腺主导管腮腺浅叶切除术的临床评价

目的探讨在腮腺浅叶切除术中保留腮腺主导管的可行性.方法对45例保留腮腺主导管的腮腺浅叶肿瘤及浅叶切除术的手术方法及术后并发症进行临床分析.结果术后1月、12月随访,45例中出现涎瘘1例,无复发、无患侧面部凹陷畸形、无口干症状.结论保留腮腺主导管的腮腺浅叶切除术能有效地减少术后涎瘘、患侧面部凹陷畸形及口干症的发生,是一种改良的可行的手术方法.     

CO2 laser tympanostomy without ventilation tubes

A new tympanostomy procedure, by CO2 laser and without ventilation tubes, which is known as tympanolaserostomy or laser-assisted tympanostomy (LAT), was compared with traditional tympanostomy with tubes. Since 1990, we have operated on 168 ears using a CO2 laser fitted with an adapter to an operative microscope. Multiple low-power impacts (0.8-1.0 W in 0.1 s) focused on a minimal spot (0. 18 mm) were preferred. This intervention did not require anesthesia and produced circular orifices 2.0 to 2.5 mm in diameter that closed in 30-40 days. Compared with 168 ears operated by tympanostomy with tubes, laser tympanostomy produced similar rates of auditive recovery by one month and only 15% of recurrence by 6 months. Recurrences were treated with laser or with tubes if prolonged ventilation was planned. After 1 to 4 years, does not require anesthesia, tubes, or hospitalization, it reduces risk and complications, and consequently decreases costs.     

Functional results in stapedotomy with and without CO(2) laser

The authors have studied the use of the CO(2) laser in performing primary stapedotomy in 451 patients affected by otosclerosis, operated between 1996 and 2000. Footplate perforation was practised with a traditional method, by means of a microdrill, in 169 subjects. A CO(2) laser was instead used in other 282 cases; the authors effected the platinotomy with a single spot, repeated if necessary, with the diameter adjusted to the caliber of the prosthesis. This procedure allowed a smooth-edged perforation to be obtained. In the 282 laser-operated patients, there was a significantly higher proportion having closure of the cochlear reserve within 10 dB than that found in the cases where the microdrill was used. Moreover, no postoperative anacusia or severe vertigo were recorded; this confirms the safety of the CO(2) laser as regards the inner ear. The functional results, therefore, document the validity of the exposed technique.     

Outpatient parotidectomy with or without the use of a post-operative drain: A retrospective bi-institutional study

Objective

Parotid surgery is historically performed as an inpatient procedure and suctions drains are predominantly used during surgery. Recent literature provides evidence that outpatient parotid surgery is safe and effective. Our study aims to describe the results of drainless outpatient parotidectomy and outpatient parotidectomy with drain placement and compare their outcomes.

Design

Retrospective cohort study.

Setting

Bi-institutional retrospective cohort study.

Participants

Patients that underwent outpatient drain-less parotidectomy and patients that underwent outpatient parotidectomy with post-operative drain placement.

Main Outcome Measures

Complication rates, unplanned post-operative visits, unplanned prolonged stay.

Results

Three hundred eighty patients underwent outpatient parotidectomy with drain placement and 31 patients underwent outpatient drainless parotidectomy in two different hospitals. The incidence of haematoma (drain: 3.1% vs. drainless: 0%, p = 1), infection (drain: 14.3% vs. drainless: 13.8%, p = 1) and salivary fistula (drain: 5.6% vs. drainless: 3.4, p = 1) were comparable between both groups. Seroma or sialocele was more frequently seen in the drain-less group (27.6% vs. 6.2%, p < .001), but were all managed conservatively. Within 10 days after surgery, unplanned visits seemed more frequent in the drain group, although the difference was not statistically significant (14.9% vs. 3.4%, p = .16).

Conclusions

Outpatient parotid surgery with or without the use of a post-operative drain is safe, practical and feasible. Same-day discharge with and without drain placement yield comparable outcomes. However, the results need to be interpreted cautiously as this study was limited by a small cohort of parotidectomies without drain placement. Future studies should further compare both approaches.     

Office CO2 laser turbinoplasty

We conducted a prospective study of office carbon dioxide (CO(2)) laser turbinoplasty as a treatment for symptoms related to turbinate dysfunction in 58 patients. All patients completed surveys before and 1 month after treatment, and 23 patients completed longer-term follow-up surveys 8 to 24 months postoperatively. The 1-month postoperative assessments demonstrated a trend toward symptom improvement, as many patients reported a decrease in their use of pretreatment medications. Long-term benefit was achieved in 70% of patients. Ten patients underwent pre- and post-treatment biopsies, and histologic evaluation demonstrated minimal tissue alteration following treatment, alleviating concerns of physiological and functional compromise. We conclude that office-based CO(2) laser turbinoplasty is a useful tool for the treatment of disorders related to turbinate dysfunction. We describe one clinician's method of performing office CO(2) laser turbinoplasty, and we report his experience and findings.     

Equipment for CO2 laser surgery

The laryngoscope designed by Kleinsasser is the most suitable for CO2 laser surgery of the larynx. This laryngoscope has been modified by two aspiration tubes mounted on the outside and opening only a short distance above the distal end of the endoscope. The expansion laryngoscope designed by Weerda is very suitable for the hypopharynx. We have shortened this endoscope by 5 cm for work in the oropharynx. The double-cupped forceps designed for microlaryngoscopy was modified by the addition of aspiration tubes. Several instruments have been developed to protect the soft tissues of the larynx from aberrant laser radiation. Their shaft has been fitted with aspiration canals to improve the extraction of smoke.