腮腺多形性腺瘤手术方式的选择

目的 探讨腮腺多形性腺瘤手术术式的选择。方法 对复旦大学附属眼耳鼻喉科医院耳鼻咽喉头颈外科1996年1月—2003年12月手术的62例腮腺多形性腺瘤患者的病史进行回顾性分析并进行随访，分析内容包括病程、肿瘤大小、术式及切除范围、术后病理、术后复发情况及并发症等。结果 在60例肿瘤最大径小于4cm的患者中，44例行腮腺浅叶切除术、16例行腮腺部分浅叶切除＋部分深叶切除术，另外2例肿瘤大于4cm的患者行腮腺全切除术。随访中所有患者术后均未发生肿瘤复发。术后病理检查示6例（10％）部分区域包膜不完整，28例（45％）细胞生长活跃，偶见核分裂象，部分区域包膜有浸润。2例（4．5％）行腮腺浅叶切除术的患者术后出现术侧暂时性面神经麻痹，16例行腮腺部分浅叶切除＋部分深叶切除术的患者无1例发生面神经麻痹，经统计学检验，上述两组患者术后面神经麻痹发生率的差异无统计学意义（Fisher确切概率法，P=0．534）。8例（18％）行腮腺浅叶切除术的患者术后出现Frey综合征，2例（13％）行腮腺部分浅叶切除＋部分深叶切除术的患者术后出现Frey综合征，经统计学检验，上述两组患者术后Frey综合征发生率的差异无统计学意义（校正卡方检验，P=0．896）。2例行腮腺全切除术的患者均出现Frey综合征，62例中Frey综合征的总发生率为19．3％（12／62）。结论 对于肿瘤最大径小于4cm的腮腺多形性腺瘤，行腮腺部分浅叶切除＋部分深叶切除术是安全的，既可取得与腮腺浅叶切除术相同的疗效，又可减少术后面神经麻痹和Frey综合征的发生率。     

腮腺肿瘤手术57例临床体会

目的探讨腮腺肿瘤手术方式、手术范围与治疗效果的关系。方法对1997～2003年间面神经解剖行腮腺肿瘤切除术57例(腮腺浅叶切除术51例，全腮腺切除术6例，1例行功能性颈淋巴结清扫术，术后加放疗4例)的临床随访资料进行分析。结果腮腺浅叶切除术51例中，并发暂时性面瘫5例，持续性面瘫1例，全腮腺切除6例中，并发暂时性面瘫2例，持续性面瘫2例，无腮腺瘘及Frey综合征，随访6月～7年无复发。结论腮腺良性肿瘤应施行解剖面神经的腮腺浅叶及肿瘤切除，恶性肿瘤在面神经尚未累及时行保留面神经的腮腺广泛切除，术后辅以放疗，可以减少肿瘤复发和面瘫等并发症的发生。     

保留腮腺浅叶手术治疗腮腺深叶良性肿瘤21例分析

目的探讨保留腮腺浅叶手术治疗腮腺深叶良性肿瘤的可行性。方法对1998～2012年收治的21例腮腺深叶良性肿瘤行保留腮腺浅叶手术切除肿瘤,并对手术疗效进行总结分析。结果采用保留腮腺浅叶手术治疗腮腺深叶良性肿瘤的21例患者术后无明显面部畸形、腮腺分泌功能良好,无Frey综合征;1例面神经损伤1个月后恢复;1例术后出现积液,加压包扎后痊愈。结论对于腮腺深叶良性肿瘤行保留浅叶腮腺深叶肿瘤切除术,术后面部畸形不明显,满足患者的美容要求,其他并发症少,值得临床推广应用。     

腮腺肿瘤的治疗经验及远期疗效观察

目的手术治疗腮腺肿瘤的多种方法及其远期疗效评定。方法回顾性分析我科自1997～2004年所收治的腮腺肿瘤手术患者病历资料86例,男性53例,女性33例,年龄23～84岁,中间年龄57岁。所有患者都作腮腺浅叶切除术或浅叶扩大切除术或腮腺全切除术,必要时作颈清扫术。常规术中快速冰冻和术后病理检查。术后面神经功能评定。恶性肿瘤患者辅助性根治放疗(50 Gy～70 Gy)。有效随访期36～120个月不等。结果86例腮腺肿瘤患者中良性肿瘤73例(85%),恶性肿瘤13例(15%)。8例腮腺深叶肿瘤中5例为恶性肿瘤。随访中良性肿瘤1例局部复发,局部控制率为98.6%(72/73);恶性肿瘤3年生存率为69.2% (9/13),3年原发灶局部控制率为84.6%(11/13),术后颈淋巴结转移率为23.1%(3/13)。术中快速冰冻与术后常规病理符合率为86%,腮腺良性肿瘤的面神经完好保存率为97.3%(71/73),恶性肿瘤面神经完好保存率为69.2%(9/13),总体面神经完好保存率为93%。结论腮腺浅叶切除术是常规基本术式,根据肿瘤具体情况可改变为腮腺浅叶扩大切除术或全腮腺切除术。术中应尽可能保存面神经主干及各分支,特别是颞面干。快速冰冻是腮腺手术中的有效诊断方法。腮腺深叶肿瘤恶变率高。     

内镜辅助下改良美容切口切除腮腺肿瘤

目的：探讨鼻内镜辅助下切除腮腺肿瘤的更隐蔽的改良美容切口。方法对2008～2012年入住本专科的17例腮腺浅叶肿瘤行改良美容切口,并在鼻内镜辅助下切除肿瘤的方法。结果17例腮腺浅叶肿瘤均一次性完成手术,伤口一期愈合,暂时性面神经分支损伤6例,包括下颌缘支4例,颧支2例,损伤面神经分支于3～6个月全部恢复正常。结论该改良美容切口位置更隐蔽,切口更短,无颈部瘢痕,具有较理想的美容效果,适合临床推广。     

腮腺多形性腺瘤的手术治疗:三种方法追踪研究

报告腮腺多形性腹瘤475例，通过追踪研究对三种手术方法进行评估。患者年龄14～93岁，平均48岁，63％为女性，左侧占49．6％，右侧占50．4％。起病时平均年龄女性50岁，男性46岁。93％表现腮腺包块，7％为腮腺包块伴疼痛，78％为活动性肿物。患者术前均无面神经功能障碍。手术方法包括单纯肿瘤摘除，腮腺浅叶切除及全腮腺切除。水中见肿瘤位于腮腺浅叶364例（77％），位于深叶68例（14％），侵及深浅两叶39例（8％），超出腮腺4例（l％），肿瘤直径0．5～14cm，平均3．3cm。223例获得完整的追踪资料，平均追踪63个月，其中腮腺浅叶切除的139…     

改良面部除皱切口在腮腺浅叶肿瘤切除术中的应用

目的：评价改良面部除皱切口在腮腺浅叶肿瘤切除术中的应用价值。方法：采用改良面部除皱切口,实施面神经解剖加腮腺浅叶部分（或腮腺浅叶）切除术35例,观察该入路的术野暴露、美观程度及并发症发生率。结果：所有病例术野暴露良好,均完整切除肿瘤。术后面神经下颌缘支暂时性麻痹5例（14．3％）,暂时性耳垂麻木6例（17．1％）,均在1～3个月后缓解;无涎瘘;术后3个月患者平均客观美容满意度评分8．5分,所有患者对术后美容效果满意。随访24～60个月（中位随访期：48个月）,未见肿瘤复发。结论：改良面部除皱切口应用于腮腺浅叶肿瘤切除,术野暴露良好、切口相对隐蔽、术后美容效果良好、无明显并发症,值得临床推广应用。     

腔镜下耳后发际线径路面神经顺行解剖后腮腺良性肿瘤切除术的临床分析

目的 探讨腔镜辅助下耳后发际线径路面神经顺行解剖后腮腺肿瘤切除手术的临床效果。方法 选择2022年7月—2022年9月诊治的3例腮腺肿瘤位于浅叶并且直径小于3cm患者，采用发际线径路，在全腔镜下顺行解剖面神经后，行腮腺肿瘤和部分浅叶切除治疗。结果 3例患者均顺利完成手术，均无术后出血、涎瘘及面瘫，收到良好的美容效果。结论 腔镜下耳后发际线径路面神经顺行解剖后腮腺良性肿物切除术是一种安全可行、有良好美容效果的手术方式。     

腮腺复发性肿瘤的手术方式及临床观察

目的探讨腮腺复发性肿瘤的病理类型、再次手术的方式及术后并发症。方法对2015~2018年我科腮腺复发性肿瘤14例患者的再次手术方式及并发症进行回顾性分析,追踪临床随访情况。结果14例患者术后复发时间半年到30年不等,7例为多形性腺瘤,其中1例恶变,其余病理包括血管性疾病、腺淋巴瘤、囊肿、木村病、腺癌等;12例为第2次手术,2例为第3次手术;10例患者行腮腺浅叶切除,4例患者行全腮腺切除,3例行放疗治疗;主要并发症为暂时性面瘫7例,持续性面瘫2例,涎瘘2例,Frey综合征1例。1例行3次手术患者复发肿瘤瘢痕组织与面神经分界不清,予以保留面神经,术后病理证实切缘为瘢痕纤维组织,未见肿瘤细胞。随访期间所有病例未见肿瘤复发。结论腮腺复发性肿瘤以多形性腺瘤最常见,再次手术建议采用浅叶或全腮腺切除,避免区域性切除,减少复发。多次手术解剖困难,神经损伤几率增加,术中可使用神经监护仪,利于神经保护。     

耳后沟切口在腮腺深叶良性肿瘤手术中的应用

目的分析探讨耳后沟切口在腮腺深叶良性肿瘤切除术中的应用。方法选取2017年1月—2022年1月在临沂市人民医院接受耳后沟切口行腮腺深叶良性肿瘤切除手术的19例患者为研究对象, 其中男11例, 女8例, 年龄17～69岁, 中位年龄48岁。其中17例肿瘤直径≤4.0 cm, 行单纯耳后沟切口;2例为哑铃型, 下颌骨内侧肿瘤前后径>4.0 cm, 肿瘤突向咽旁间隙, 经耳后沟切口联合口内切口切除腮腺深叶及肿瘤。结果 17例肿瘤经耳后沟切口完全摘除, 2例哑铃型肿瘤经口内切口取出, 术后病理多形性腺瘤13例、基底细胞腺瘤4例、Warthin瘤2例。2例患者出现暂时性下颌缘支麻痹, 术后3周恢复至正常。所有患者全部一期愈合。经过1～5年的随访, 中位随访时间3.1年, 患者均未出现Frey综合征和涎瘘, 均未出现其他并发症, 肿瘤无复发。患者及家属对术区面部外形、切口瘢痕外观满意。结论耳后沟切口入路应用于腮腺深叶良性肿瘤的手术治疗, 不仅保留了腮腺浅叶及面神经的功能, 同时具有创伤小、组织缺损少、瘢痕隐蔽、并发症及复发率低、美容效果好等优点, 值得临床推广应用。     

Selective deep lobe parotid surgery for benign tumors

Conclusions: Deep-lobe tumor parotidectomy decreases the incidence of parotidectomy post-surgical complications, preserves parotid function, and has a good esthetic appearance. Objective: The existing surgical technique in the parotidectomy of deep-lobe benign tumors can be improved. Methods: Fourteen surgical operations were performed (2004–2015) for selective deep lobe parotidectomy for patients with primary benign parotid tumors. The patients with deep-lobe benign tumors were operated on with the method of superficial lobe preservation, which included methylene blue staining of the gland and intra-operative facial nerve detection. Results: During follow-up, no cases of tumor recurrence, permanent facial nerve injury, postparotidectomy depression, or Frey’s syndrome was found.     

Preservation of the superficial lobe for deep-lobe parotid tumors: a better aesthetic outcome

Deep-lobe parotid tumors are relatively uncommon. Most of these tumors present as external masses. They can also present in the oral cavity or oropharynx. Magnetic resonance imaging and ultrasound-guided fine-needle aspiration for biopsy and cytology have made it possible to establish a definitive diagnosis and identify the exact location of the tumor in almost all cases before surgery. Traditionally, deep-lobe tumors have been managed by a formal superficial parotidectomy and identification and preservation of the facial nerve, followed by removal of the deep lobe that contains the tumor Superficialparotidectomy is associated in most cases with periauricular depression secondary to a loss of volume, leading to variable aesthetic deformities. A complete parotidectomy is more likely to be associated with a larger aesthetic deficit secondary to a greater loss of tissue volume. The incidence of gustatory sweating is high after superficial parotidectomy, particularly in the early postoperative period. We hypothesize that if the superficial lobe is preserved, there is less likelihood of gustatory sweating because of the interposition of tissue between the skin and the cut ends of the secretomotor fibers. Approximately 80% of parotid tissue volume is made up of the superficial lobe, and therefore preservation of the superficial lobe should be associated with less postparotidectomy depression. Therefore, we decided to preserve the superficial lobe of the gland for deep-lobe tumors. Nine patients underwent deep-lobe parotidectomy with preservation of the superficial lobe over a 6-year period. Patients were studied prospectively with regard to technical difficulty, complications, and cosmetic outcome. Follow-up ranged from 12 months to 6 years. We did not experience any undue technical difficulty, and there were no cases of facial weakness. One patient developed gustatory sweating, which almost completely resolved over a 2-year period. There were no cases of post parotidectomy depression, and both patients and surgeons were satisfied with the cosmetic appearance. We present our technique and experience.     

Warthin tumor. Report of eight cases and review of the literature

We have studied 8 patients with Warthin's tumor of the parotid gland (WT). Seven of them were men and smoked more than a packet daily. Seven were operated with conservative superficial parotidectomy and the other one with total parotidectomy with facial preservation. Two had postoperative peripheral facial paresia which disappeared with medical treatment in few days. One of the operated suffered from postoperative Frey's syndrome.     

Limited parotidectomy: the role of extracapsular dissection in parotid gland neoplasms

OBJECTIVE: Surgical techniques for parotid gland neoplasm removal have been shaped over the years by the importance of the gland's relationship with the facial nerve, histologic behavior of parotid tumors, and recurrence rates from specific techniques. Parotidectomy with facial nerve dissection has become the procedure of choice in removal of parotid gland neoplasms because of the resulting low recurrence rate. However, these more comprehensive dissections can cause significant postoperative complications, some cosmetically devastating. We propose that a more limited dissection yields a similar low recurrence rate but with less risk of complications. STUDY DESIGN: Retrospective case series. METHODS: A retrospective review of the clinical outcomes and pathology of 27 patients who underwent extracapsular dissection for parotid gland neoplasms. RESULTS: All tumors were located in the superficial lobe of the parotid gland and size of the masses ranged from 4.0 to 1.0 cm (mean 2.4 cm) in diameter. Pathology of the parotid tumors consisted of 11 pleomorphic adenomas, six Warthin's tumors, six benign epithelial cysts, one sarcoid lesion, two lymphoid hyperplasia, and one Kaposi's sarcoma. There were no cases of capsular rupture. There was no temporary or permanent facial paralysis and no incidence of Frey's syndrome. One patient developed a sialocele, which was aspirated and resolved after 3 months. There were no recurrences with follow-up times between 5 months and 6 years (mean 41 mo). CONCLUSION: We advocate extracapsular dissection for benign parotid neoplasms because of the acceptable recurrence rates with limited complications as compared to superficial parotidectomy.     

Role of limited parotidectomy in management of pleomorphic adenoma

There is continued controversy over the extent of parotidectomy required for removal of a benign pleomorphic adenoma from the parotid gland. Currently, consensus exists that the integrity of the facial nerve must be preserved when the tumour is totally removed. As a result of experience gained in the first half of the twentieth century, it was recommended that superficial parotidectomy with facial nerve dissection should be the minimal biopsy for pleomorphic adenoma. Since that time, however, research has indicated that partial parotidectomy or extracapsular dissection of benign pleomorphic adenoma can be accomplished with preservation of the facial nerve without an increase in tumour recurrence. Partial parotidectomy or extracapsular dissection results in impaired cosmetic results and a lower incidence of Frey's syndrome, and thus may be the preferred approach when undertaken by experienced surgeons.     

Minimally invasive surgery for parotid pleomorphic adenoma

Compared with total parotidectomy and complete superficial parotidectomy for the removal of a parotid pleomorphic adenoma, partial superficial parotidectomy with dissection and preservation of the facial nerve--defined as the excision of a tumor with a 2-cm margin of normal parotid parenchyma except at the point where the tumor abuts the facial nerve--is associated with a lower incidence of transient facial nerve dysfunction, facial contour disfigurement, and subsequent Frey's syndrome. The partial procedure is not associated with any increase in recurrence, and it requires less operating time. The author hypothesized that the use of this procedure to remove a benign pleomorphic adenoma might result in even less morbidity (transient or permanent facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and hypoesthesia) without increasing the risk of recurrence if only a 1-cm margin of normal parotid parenchyma was removed and if the posterior branches of the great auricular nerve were preserved To test this hypothesis, the author conducted a retrospective study of 30 patients--15 who had undergone the standard partial procedure (2-cm margin with great auricular nerve sacrifice) and 15 who had undergone the modified version (1-cm margin with great auricular nerve preservation). After a mean follow-up of 10 years, there were no significant differences between the two groups in terms of facial nerve dysfunction, facial contour disfigurement, Frey's syndrome, and recurrence. Moreover, preservation of the posterior branches of the great auricular nerve did not prevent alterations in sensitivity (i.e., hypoesthesia) in 7 of the 15 patients (46.7%). Although a 1-cm area of normal parotid parenchyma around a benign pleomorphic adenoma was a safe margin, it was no better than a 2-cm margin in terms ofmorbidity and recurrence. Preservation of the posterior branches of the great auricular nerve will result in an objective reduction in hypoesthesia in approximately half of patients, but because it does not ensure freedom from sensitivity alterations in all cases, patients should be advised of the risk of postoperative numbness in the earlobe and the infraauricular area.     

显微镜下功能性腮腺切除术治疗腮腺良性肿瘤42例

目的 评价显微镜下功能性腮腺切除术治疗腮腺良性肿瘤的临床疗效。方法 采用显微镜下功能性腮腺切除术,治疗腮腺浅叶良性肿瘤患者42例。该术式较传统术式改良之处主要有：全程显微镜下手术直观准确;切口改良、美容;腮腺嚼肌筋膜下翻瓣;解剖保留耳大神经后支和腮腺导管;只解剖暴露面神经的部分分支;包括肿瘤在内的腮腺浅叶部分切除;胸锁乳突肌肌瓣填塞术腔等。结果 42例术后出现面神经损伤3例(7.1%),损伤均为暂时性;出现Frey综合征者1例(2.4%);发生涎瘘者0例;5例(11.9%)患者术后出现不同程度的耳垂和耳郭背部皮肤感觉减弱;术后局部凹陷不明显,患者对颜面部外观满意。术后随访1～5年,未见肿瘤复发。结论 显微镜下功能性腮腺切除术治疗腮腺良性肿瘤,既降低手术并发症发生率,又可取得良好美容效果。     

Deep lobe parotidectomy: clinical rationale in the management of primary and metastatic cancer

Deep lobe parotidectomy is an important management approach for highgrade primary parotid cancers that metastasize to the deep lobe nodes and for cancers that metastasizes to the deep parotid from a site outside the parotid. This paper reviews the rationale for deep lobe parotidectomy with facial nerve preservation for these parotid cancers. Deep lobe parotid involvement was reviewed in 27 patients. Twelve patients had primary parotid tumors that metastasized to the deep lobe, and 15 had tumors outside the parotid that metastasized to deep parotid nodes. Deep lobe parotidectomy should be considered in patients with a highgrade primary parotid tumor, a cancer that metastasizes to a superficial intraparotid node, or a primary parotid malignancy that metastasizes to a superficial parotid node or a neck node.     

腮腺良性肿瘤的手术方式与术后复发和并发症

目的;研究腮腺良性肿瘤手术方式与复发和术后并发症的关系。方法 在１９８７～１９９７年手术治疗腮腺良性肿瘤５５例（单纯肿瘤除２０例,腮腺浅地切除２８例,全腮腺切除７例）的临床随访资料进行分析。结果 单纯肿瘤切除中肿瘤复发６例,并发持续性面瘫１例,腮腺浅叶切除中复发１０例,并发暂时性面瘫４例腮腺瘘２例,Ｆｒｅｙ综合征２例,腮腺全切除中复发１例,并发暂时性面瘫２例,持续性面瘫１例,腮腺瘘２例,Ｆｒｅｙ综