腮腺肿瘤的美学切除技术研究进展

手术切除是腮腺肿瘤的重要治疗手段,减少神经损伤、预防术后并发症发生及疾病复发是手术治疗的关键.传统手术切口瘢痕明显,容易出现局部凹陷及味觉出汗综合征等美学问题.随着医疗技术的进步,颌面部外科手术在手术切口及切除技术等方面作了改进.本文将回顾腮腺肿瘤手术切除方法,介绍美学切除技术类型及其临床应用现状,为解决该病手术治疗中...     

腮腺切除术中几个美学问题的探讨

目的：探讨腮腺切除术中切口瘢痕、术区凹陷畸形、味觉出汗综合征等几个美学问题的预防方法。方法：对36例腮腺良性肿瘤采用改良的腮腺类＂3＂型切口、耳后筋膜瓣、保留腮腺嚼肌筋膜、保留腮腺总导管及深叶功能等综合术式。结果：切口瘢痕得到有效隐蔽、局部凹陷得以改善、味觉出汗综合征明显降低。结论：腮腺切除术中采用综合的术式,可以大大改善切口瘢痕、术区凹陷畸形及味觉出汗综合征等导致的美学问题。     

十二指肠肿瘤局部切除术

1概述十二指肠肿瘤可发生于十二指肠各段,以原发性十二指肠肿瘤多见,原发性十二指肠肿瘤约占整个小肠肿瘤的20%~25%[1]。手术切除是治疗十二指肠肿瘤的首选方法:早在1899年Halstead针对常见的十二指肠壶腹部肿瘤提出了局部切除的手术方案,最初阶段的手术方法包括楔形切除壶腹、     

腮腺美容切口治疗腮腺肿瘤临床效果探讨

目的：探究腮腺美容切口治疗腮腺肿瘤的临床效果。方法：选取2017年1月-2020年2月笔者医院收治的106例腮腺肿瘤患者为研究对象。根据随机数字表法分为观察组(52例)和对照组(54例),对照组采用传统S形切口入路切除术,观察组采用V形切口入路切除术。观察两组手术效果、美学效果、面神经功能、生活质量及并发症情况。结果：观察组手术时间、切口长度、住院时间均短于对照组,术中出血量、术后引流量低于对照组(P<0.05);观察组术后用温哥华瘢痕量表与患者和观测者瘢痕评价量表评分低于对照组(P<0.05),差异有统计学意义。观察组术后H-B面神经功能评分高于对照组;观察组术后生活质量评分高于对照组,差异均有统计学意义(均P<0.05)。与对照组比较,观察组口干、面部凹陷畸形、Frey’s 综合征、暂时性面瘫及术区麻木发生率均较低,差异有统计学意义(P<0.05)。结论：V形切口入路治疗腮腺肿瘤的疗效、美学效果及面神经功能较传统S形切口入路好,有利于提高患者生活质量,改善术后并发症发生情况。     

十二指肠乳头肿瘤局部切除术

十二指肠乳头肿瘤局部切除术具有维持人体正常的消化道通路、手术创伤小、并发症少等优点.但由于存在技术要求高、精细程度大、并发症处理困难、长期疗效有待循证医学的验证等问题,该手术未能普及.2000年1月至2012年6月上海交通大学医学院附属仁济医院实施了4例十二指肠乳头肿瘤局部切除术.患者术前均经ERCP检查确诊患有十二指肠乳头肿瘤,肿瘤直径＜1 cm,行十二指肠乳头活组织检查,3例为中至重度不典型增生,1例为腺癌,术前行CT、MRI检查均未见肿大淋巴结或远处转移,故选择行十二指肠乳头肿瘤局部切除术.术后病理检查示1例为十二指肠乳头腺瘤,3例为十二指肠乳头腺癌,切缘均为阴性,肝十二指肠韧带淋巴结无转移.术后除1例发生少量胰液漏外,其余均无并发症发生.术后随访3～24个月,4例患者均无肿瘤复发.严格掌握十二指肠乳头肿瘤局部切除术的手术适应证与手术操作规范是取得良好临床疗效的关键.     

Mason手术在低位直肠肿瘤切除术中的作用

目的探讨Mason手术在低位直肠肿瘤切除术中的作用。方法对采用Mason手术治疗的85例低位直肠肿瘤病例进行回顾性分析。结果病理检查结果为直肠绒毛状腺瘤29例，直肠癌47例，直肠类癌等9例。直肠癌中Tis期17例，T1期19例，T2期7例，T3期1例，T4期3例。术后合并伤口感染2例（2．3％），直肠皮肤瘘2例（2．3％）。无手术死亡，无术后肛门失禁。术后3年和5年生存率分别为100％和95．5％。结论Mason手术具有手术径路直达，术野宽敞，显露良好，十分适用于低位直肠肿瘤的治疗。     

改良S形切口入路腮腺切除术治疗腮腺肿瘤的美学效果研究

目的：探讨改良S形切口入路腮腺切除术治疗腮腺肿瘤的美学效果。方法：选取2018年1月-2021年1月就诊于笔者医院口腔颌面外科并行手术治疗的69例患者,其中34例采用改良“S”形切口入路腮腺切除术作为观察组,35例采用常规腮腺切除术作为对照组。采用视觉模拟量表评估术后美学效果和满意度;记录两组住院时间、手术时间及术中出血量;采用华盛顿大学生存质量问卷(University of Washington quality of life questionnaire,UW-QOL)对患者术后半年的生活质量进行评分;统计两组并发症发生率。结果：观察组美学效果和满意度评分高于对照组,差异有统计学意义(P<0.05)。两组手术时间、术中出血量比较差异无统计学意义(P>0.05);但观察组住院时间短于对照组,差异有统计学意义(P<0.05)。观察组术后情绪、疼痛、唾液、咀嚼、味觉各项生活质量评分均高于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率为8.82%低于对照组的28.57%,差异有统计学意义(P<0.05)。结论：改良“S”形切口入路腮腺切除术可提高...     

68例腮腺肿瘤病人的术后护理

腮腺肿瘤的治疗方法主要是手术。由于腮腺与面神经在解剖上密切相连，因此，术后可能发生暂时性及永久性面神经功能障碍及其他并发症。术后密切观察，发现问题及时处理甚为重要。1987～t997年我科对68例腮腺肿瘤进行了手术治疗，对付后所发生的并发症及主要护理问题，采取了相应的护理措施，取得一定效果。总结如下。Ill＄床资料和方法68例中，男33例，女35例，年龄14～72岁，平均45．5岁。病程1个月至40年，平均1年半。腮腺肿瘤直径＜2cm6例，2—6cm58例，＞6cm4例。瘤体原发于腮腺浅叶49例，深叶19例。病理类型：良性肿瘤55例，恶性肿瘤1…     

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.     

腮腺肿瘤摘除术后使用红外线照射术野的效果

目的观察腮腺肿瘤摘除术后使用红外线照射术野的效果。方法将50例腮腺良性肿瘤患者随机分为观察组(27例)和对照组(23例)。对照组手术后实施常规护理措施,观察组在此基础上,手术后第2天辅以红外线灯照射术野,照射时间15～20min/次,1～2次/d。结果观察组患者术后48h内VAS的最大评分显著低于对照组,拔除引流管时间及住院时间显著缩短(均P0.01)。结论腮腺肿物摘除术后第2天辅以红外线照射术野,能有效改善局部血液循环,促进炎症消退、水肿吸收,达到尽早拔除引流管、减轻疼痛的目的 。     

Vascular control for resection of suprahepatic intracaval Wilms' tumor: technical considerations

The surgical resection of Wilms' tumor can be complicated by tumor thrombus extension into the inferior vena cava. In cases of suprahepatic Wilms' tumor thrombus that may extend into the right atrium, a median sternotomy and cardiopulmonary bypass (CPB) are used to facilitate tumor resection. However, if the tumor can be localized and controlled below the atrium, resection without the use of cardiopulmonary bypass may limit morbidity. The authors describe a novel approach to tumor thrombectomy for a Wilms' tumor extending to the suprahepatic vena cava without the use of CPB. The authors used transesophageal echocardiography to localize the tumor thrombus and detect any tumor or air embolization and a minimal lower sternotomy to obtain intrapericardial control of the inferior vena cava. This technique may be useful in selected cases of Wilms' tumor as an alternative to median sternotomy and use of cardiopulmonary bypass.     

Aesthetic considerations and the pediatric population

Aesthetic surgery is the natural evolution of reconstructive surgery done to improve a patient's form in addition to function. This becomes especially critical in the pediatric age group in which patients are constantly evolving and their concepts of self-esteem and body image are so fragile.     

Surgical treatment of tumor metastases: General considerations and results

The prerequisite for a curative resection of metastases is their restriction to the key organs, the liver and lungs, in the sense of a limited dissemination. For long-term prognosis, the type of primary tumor as well as the radical resection of lung and liver metastases is essential. To improve the process of surgical indication and therapy of tumors, clear definitions for the terms tumor recurrence and metastases have been agreed upon. Research and clinical investigation have led to a better understanding of tumor-regulating factors, some of which are briefly described: Metastasis promoting factors include the lack of E-cadherin, which leads to a local penetration of basal membranes by tumor cells; CD44 seems to play an important role in cell-cell and cell-matrix interactions, apparently increasing the metastatic potential of tumors and reducing the long-term survival of patients. High levels of urokinase in primary tumors are also associated with a poorer prognosis, as well as plasminogen inactivator inhibitor PAI II, which plays a crucial role in tumor growth. Positive findings in bone marrow aspirates of patients with different malignancies, stained for cytokeratin 18, either are associated with higher recurrence rates in colon and breast cancer or can be correlated to the prognosis of patients with gastric cancer. Technical aspects of surgery for hepatic, pulmonary and skeletal metastases are presented and discussed with respect to curative and palliative indications.Presented at the XCIV Annual Congress of Japan Surgical Society. Tokyo, March 1994     

Aesthetic considerations in facial reanimation

The treatment results of facial paralysis have improved within the last two decades with the introduction of new techniques for neuromuscular reconstruction. However, many patients still complain of aesthetic imbalance impairment after treatment. This article presents some complementary procedures that can be used to improve the appearance of the face either isolated in incomplete palsies, or after the completion of reconstructive procedures in complete paralysis. The procedures are divided according to anatomical areas--forehead, eyelids, middle third of the face, and the lower lip.     

Aesthetic considerations in mandibular reconstruction

As free tissue transfer methods have improved, vascular bone grafting has become state of the art for reconstruction of mandibular defects. Prior studies have focused on flap survival and functional outcomes. The reconstructive surgeon should also strive to attain lofty aesthetic goals for this group of patients. The best results are achieved when patient factors, flap selection, treatment planning, and surgical techniques are all considered and properly selected.     

Aesthetic considerations in scalp reconstruction

This article reviews common methods of reconstructive surgery in patients with wounds that involve the scalp, including primary wound repair, healing by secondary intention, and the use of skin grafts, local tissue flaps, regional myocutaneous flaps, and microvascular free flaps. Special attention is paid toward consideration of aspects of the reconstruction that affect the aesthetic outcome, including preservation of the hairline and hair follicle orientation, scar camouflage, avoidance of alopecia, and secondary restoration of alopecia.