Endoscopic versus conventional parotid gland excision: a systematic review and meta-analysis

The objective of this review was to conduct a systematic review and meta-analysis to compare endoscopic with conventional parotid tumour excision. Online databases including MEDLINE, EMBASE, EMCare, CINAHL, the Cochrane Central Register of Controlled Trials (CENTRAL), the World Health Organization International Clinical Trials Registry (ICTRP), and the ISRCTN registry were all searched. All randomised controlled trials and observational studies comparing endoscopic with conventional parotid tumour excision were included. Five studies were identified and analysis was reported in forest plots with 95% confidence intervals. Outcomes of interest included operating time, cosmesis, blood loss, facial nerve injury, Frey syndrome, duration of hospital stay, and tumour recurrence. Endoscopic tumour excision had a comparable operating time to conventional resection with an insignificant mean difference (p=0.08). Scar cosmesis in the endoscopic group was superior (mean difference: 2.95, p<0.05) and it also reported a lower volume of blood loss (mean difference: -31.84, p<0.05). No significant difference was found in the incidence of facial nerve injury or Frey syndrome between the two groups, but overall, fewer miscellaneous complications were observed in the endoscopic cohorts. Endoscopic parotid surgery reported a shorter duration of hospital stay, and tumour recurrence was similar in both treatment arms. Endoscopic parotid gland surgery is an effective alternative to conventional approaches with comparable operating times, reduced blood loss and fewer complications, as well as shorter inpatient stay and improved cosmesis. Further studies are, however, required with longer follow-up periods to assess outcomes between different subtypes of parotid tumour.     

Comparison of postoperative complications and facial nerve recovery rates after conventional and partial superficial parotidectomy of benign parotid tumours: a prospective study

The aim of this study was to compare postoperative complications and facial nerve (FN) recovery rates between conventional superficial parotidectomy (CSP) and partial superficial parotidectomy (PSP) as surgical treatment for benign parotid tumours. A prospective study was conducted on 55 consecutive patients who underwent either CSP (n = 35) or PSP (n = 20) for benign parotid tumours. The primary outcomes were FN injury, FN recovery rates, and Frey syndrome. Secondary outcomes were operative time, hospital stay, sialocele, haematoma, and auricular numbness. The degree of FN injury was evaluated at 1 week, 1, 3, 6, and 12 months postoperative using the House–Brackmann grading system. Frey syndrome was assessed using a subjective clinical questionnaire and objective Minor starch–iodine test. No patient in either group experienced permanent FN paralysis. There was a significantly higher incidence of temporary FN weakness in the CSP group (P = 0.007). The respective FN recovery rates at 1, 3, 6, and 12 months were 60%, 88.6%, 94.3%, and 100% in the CSP group and 90%, 95%, 100%, and 100% in the PSP group. No significant difference was observed between the groups regarding the incidence of Frey syndrome, sialocele, and haematoma. The operative time and hospital stay were both shorter in the PSP group. Although the PSP is a more conservative procedure with significantly reduced FN injury, operative time, and hospital stay compared to CSP, the CSP procedure shows a comparable FN recovery rate to the PSP.     

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目的比较持续负压引流与橡皮片加压包扎在预防腮腺术后并发症中的临床疗效。方法回顾性分析2006—2010年包头市中心医院行腮腺切除术患者142例,其中腮腺术后持续负压引流75例,橡皮片加压包扎67例。将术后有无积血、涎液潴留、涎瘘及感染做评价分析,采用卡方检验分析腮腺术后持续负压引流与橡皮片加压包扎出现并发症的关系。结果腮腺术后负压引流与橡皮片加压包扎出现并发症发生率分别为4%和10.77%,两者间差异有统计学意义(P<0.05),前者能明显降低术后并发症的发生率。结论持续负压引流是较橡皮片加压包扎更为有效的预防腮腺术后并发症的方法。     

腮腺多形性腺瘤区域性切除术与浅叶切除术的比较研究

目的 比较腮腺多形性腺瘤区域性切除术与浅叶切除术两种术式的术后复发率及并发症发生情况,为临床合理选择术式提供依据.方法 总结1998年1月～2004年6月间收治的腮腺多形性腺瘤61例,其中24例采用腮腺区域性切除术,37例行腮腺浅叶切除术,随访时间3～9年.结果 采用腮腺区域性切除手术的病例术后面瘫、Frey综合征、涎瘘的发生率均低于腮腺浅叶切除术,而肿瘤的复发率无明显差异.结论 区域性切除术手术创伤小,并发症少,还可以保存腮腺一定的功能,可作为腮腺多形性腺瘤临床治疗的首选术式.     

A meta-analysis of the pros and cons of partial superficial parotidectomy versus superficial parotidectomy for the treatment of benign parotid neoplasms

ObjectivesSalivary gland tumors are predominantly benign and frequently localized in the parotid gland (P). The treatment consists primarily of surgical removal; however, the appropriate extent remains a subject of debate. In suitable tumors, superficial parotidectomy (SP) may be substituted for less invasive partial superficial parotidectomy (PSP) (I C). This systematic review analyzed the available literature, comparing PSP and SP with regards to several postoperative outcome parameters (O).Materials and methodsEstablished medical databanks were screened for articles evaluating outcomes of PSP compared with SP, published between 1955 and 2019. These data were assessed by pooled risk and odds ratios via meta-analysis.Results11 studies with 1272 patients were included. There was no significant difference in tumor recurrence between PSP and SP (primary outcome). Furthermore, no differences in the occurrence of permanent facial nerve paralysis (FNP), salivary fistula, great auricular nerve analgesia, or hematoma were observed between the groups. However, PSP displayed significantly reduced rates of transient FNP, Frey's syndrome, scar deformity, and xerostomia, as well as shorter surgical time, compared with SP (secondary outcomes).ConclusionBased on these data, PSP can be recommended as a surgical technique for the treatment of superficially located, small, benign parotid tumors.     

腮腺良性肿瘤部分切除术的临床探讨

目的 观察腮腺良性肿瘤部分切除术与传统腮腺浅叶切除术术后并发症的比较,探讨部分切除术的合理性。 方法 选择腮腺浅叶良性肿瘤患者103例,其中53例采用腮腺部分切除术治疗,在距肿瘤边界0.5~ 1.0 cm 处的正常腺体内切除肿瘤,保留腮腺咬肌筋膜、耳大神经分支。50例采用传统腮腺浅叶切除术。随访0.5~ 5年,观察并比较（卡方检验）2组并发症的发生率及肿瘤复发情况。 结果 腮腺浅叶良性肿瘤部分切除术术后较少出现面部畸形,腮腺功能良好,相对于传统腮腺浅叶切除术组,Frey综合征、口干、耳垂区麻木以及术后暂时性面瘫、涎瘘等术后并发症发生率均明显减少（P＜0.05）。2组患者术后肿瘤均无复发。 结论 腮腺浅叶良性肿瘤部分切除术既能保证腮腺良性肿瘤彻底切除,又可以显著减少各类手术并发症。     

副腮腺肿瘤14例临床分析及治疗体会

目的 初步评估分析副腮腺肿瘤的诊断、治疗与预后情况。方法 回顾性分析14例副腮腺肿瘤患者的诊断与治疗,考虑到副腮腺肿瘤的特殊解剖部位,14例患者均采取常规的腮腺肿瘤手术切口,并进行细致的面神经解剖。对于恶性副腮腺肿瘤给予术后辅助放射治疗。结果 14例副腮腺肿瘤中多形性腺瘤6例,肌上皮瘤2例,腺泡细胞癌2例,基底细胞腺瘤1例,中分化黏液表皮样癌1例,肌上皮癌1例,侵袭性纤维瘤1例。所有患者术后的面型满意,肿瘤无复发。结论 常规的腮腺手术切口进路治疗副腮腺肿瘤是一种安全、有效、美观的方法。     

改良耳后发际切口联合蒂在下胸锁乳突肌瓣在腮腺良性肿瘤切除术中的应用研究

目的 评价改良耳后发际切口联合蒂在下胸锁乳突肌瓣修复腮腺良性肿瘤中的应用价值.方法 回顾性分析48例接受腮腺良性肿瘤切除术的患者,其中试验组采用改良耳后发际切口联合蒂在下胸锁乳突肌瓣修复19例,对照组采用改良美容切口29例,比较两组的手术时间、术后引流量、术后美观程度及术后面神经麻痹、涎瘘、Frey综合征的发生率.结果...     

Comparison of surgical techniques for benign parotid tumours: a multicentre retrospective study

This study aimed to compare the outcomes of three surgical techniques for the treatment of patients with benign parotid tumours: superficial parotidectomy (SP; group 1), partial superficial parotidectomy (PSP; group 2), and ultrasonic scalpel-assisted minimal extracapsular dissection (US-MECD; group 3). Groups 1 and 2 received the conventional surgical technique, while group 3 underwent surgery with an ultrasonic scalpel. A total of 281 patients treated during 2012–2016 were included: 98 in group 1, 91 in group 2, and 92 in group 3. The mean surgical time and blood loss during surgery, as well as drainage time and amount, were significantly lower for US-MECD (P < 0.01). The great auricular nerve and parotid fascia were both preserved with US-MECD (P < 0.01), while the rate of capsule rupture with US-MECD was slightly higher than in the other groups (P > 0.05). There was less transient facial nerve paralysis and Frey syndrome with US-MECD (P < 0.01). No significant difference in wound infection, sialocele, or permanent facial nerve paralysis was observed among the three groups. Patients enrolled during 2012–2013 were selected to evaluate the recurrence rates, and no statistically significant differences were found among the groups. In conclusion, US-MECD showed similar effectiveness and fewer side effects than SP and PSP. The long-term effects of the new technique require further study.     

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目的探讨保留腮腺主导管的腮腺部分切除术在治疗肿瘤直径小于2.0cm的腮腺良性肿瘤的可行性。方法对2002—2006年江苏泰州普济医院口腔科收治的43例直径小于2.0cm的腮腺深浅叶良性肿瘤病例,作保留腮腺主导管的腮腺部分切除术,于肿瘤外0.5～1.0cm处切除肿瘤与周围正常腺体组织。结果采用腮腺部分切除手术的病例术后瘢痕、面部凹陷畸形、味觉出汗综合征(Frey综合征)、暂时性面瘫发生及腮腺功能等方面均优于传统的腮腺浅叶及全叶切除术。结论对于界限清楚、直径小于2.0cm的腮腺良性肿瘤,采用腮腺部分切除术是可行的,并有诸多优点。     

胸锁乳突肌肌瓣与美容切口在腮腺肿瘤术中的应用

目的 探究胸锁乳突肌肌瓣与美容切口在腮腺肿瘤术中的手术效果,以及患者满意度的情况。 方法 研究对象选取为2015年1月~2017年6月我院收治的74例腮腺肿瘤患者,采用数字表法随机分为观察组和对照组各37例,两组患者均沿耳屏缘内侧向下做美容切口并切除肿瘤,观察组在切除肿瘤后将胸锁乳突肌肌瓣修复术区缺损,对照组不做任何修复处理,对比两组患者的术中出血量、手术时间、住院时间等手术指标,对比两组患者的术后并发症情况,并采用满意度问卷调查两组患者的手术满意度。结果 两组患者的术中出血量、手术时间、住院时间对比无显著差异（P＞0.05）;两组患者术后暂时性面瘫、涎瘘、耳垂麻木发生率对比无显著差异（P＞0.05）,观察组术区凹陷畸形、Frey综合征发生率显著低于对照组（P＜0.05）;观察组患者满意度为94.6%（34/37）,显著高于对照组的67.6%（25/37）,差异具有统计学意义（P＜0.05）。结论 胸锁乳突肌肌瓣修复腮腺肿瘤术后缺损不会影响手术时间及术中出血量,同时可有效减少术后并发症的发生,提高患者的手术满意度,值得在临床上应用和推广。     

腮腺区域性切除术在治疗腮腺浅叶多形性腺瘤中的体会

目的探讨腮腺多形性腺瘤两种术式的术后复发率及并发症发生情况,为临床合理选择术式提供依据。方法总结1999年1月至2007年1月间汕头市第二人民医院收治的腮腺多形性腺瘤90例,其中44例采用腮腺区域性切除术,46例行腮腺浅叶切除术,随访时间2～9年。结果采用腮腺区域性切除手术的病例术后面瘫、Frey综合征、涎瘘的发生率均低于腮腺浅叶切除术,而采用两种术式肿瘤的复发率差异无统计学意义。结论区域性切除术手术创伤小．并发症少,还可以保存腮腺一定的功能,可作为腮腺多形性腺瘤临床治疗的首选术式。     

内镜辅助下经颅耳沟切口行腮腺良性肿瘤包膜外切除术

目的探讨一种内镜辅助下经颅耳沟切除腮腺良性肿瘤的方法。 方法60例腮腺浅叶良性肿瘤患者采用随机数字表法分成内镜组及传统手术组两组。统计并比较两组患者围手术期以及术后情况,包括肿瘤的最大直径、切口的长度、手术时间、术中出血量、术后引流量及引流时间,美观满意度,术后并发症及随访情况。利用SPSS 18.0进行数据的统计分析,采用t检验和卡方检验评价两组间的差异性。 结果两组的肿瘤直径接近（t= 0.253,P= 0.234）,所有的手术过程均按预期完成。内镜组平均切口长度（3.5 ± 0.4）cm小于传统手术组（9.0 ± 1.7）cm,差异有统计学意义（t= 16.645,P<0.001）。内镜组术中出血量（t= 16.028,P<0.001）、术后引流量（t= 6.499,P= 0.003）、围手术期并发症（χ²= 4.423,P= 0.035）以及外观效果（t= 16.285,P<0.001）均较传统手术组更好。术后随访10 ~ 40个月,无肿瘤复发。 结论颅耳沟切口隐蔽,内镜辅助下应用颅耳沟切口行腮腺良性肿瘤包膜外切除术适用且可靠,可以缩小手术切口并能获得满意的美观效果。     

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目的探讨腮腺多形性腺瘤的治疗方法。方法通过对1992—2009年江苏省徐州市第六人民医院口腔科收治的148例腮腺多形性腺瘤患者的临床资料进行总结,比较分析腮腺浅叶切除术(88例患者)与腮腺区域性切除术(60例患者)两种术式治疗腮腺多形性腺瘤的效果。结果采用腮腺区域性切除术治疗的病例,术后瘢痕、局部凹陷畸形、暂时性面瘫、涎瘘、Frey综合征及腮腺功能等方面明显优于采用腮腺浅叶切除术的病例。两种术式的术后复发率差异无统计学意义。结论应根据肿瘤的部位及大小选择不同的术式,对界限清楚、体积较小的腮腺浅叶多形性腺瘤应尽量采用腮腺区域性切除术,预防面部凹陷畸形,减少并发症;对过大或边界不清的肿瘤仍宜采用传统腮腺浅叶切除术,以减少复发。     

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目的分析腮腺肿瘤的临床和病理学特点,提高腮腺肿瘤诊断水平和,临床治愈率。方法选择2010年9月至2011年2月中国医科大学附属口腔医院口腔颌面外科收治的经组织病理学确诊的腮腺区肿瘤患者145例,对其临床和病理学特点进行回顾性分析。结果145例腮腺肿瘤中,良性肿瘤118例,恶性肿瘤27例。良性肿瘤术后有暂时性面瘫6例,涎瘘1例,味觉出汗综合征1例;恶性肿瘤复发2例,永久性面瘫2例。结论腮腺区肿瘤治疗首选手术方式,且术式选择应根据肿瘤的实际情况来决定。     

副腮腺肿瘤切除的手术入路

目的探讨副腮腺肿瘤外科治疗的最佳手术入路。方法对笔者近年所做的9例副腮腺肿瘤手术入路分别采用了延长的腮腺切除手术入路;肿瘤表面皮肤纹理的直接手术入路以及耳前发际内的角形切口手术入路三种方法。结果上述3种不同的手术入路在手术损伤大小、切口隐蔽、副腮腺肿瘤的术野显露以及并发症的发生率等方面存在明显差异。结论耳前角形切口应作为副腮腺肿瘤切除的首选手术入路,它具有更好的美容及手术治疗效果．     

A novel method of managing persistent parotid sialocele

Sialocele formation is a recognised complication of parotid surgery. The initial management is usually conservative and often effective. We present a novel method that utilises an intra-oral approach and pig-tail catheter for safely and rapidly draining a large persistent sialocele. It is particularly appropriate when other methods have failed and the skin is at risk of breakdown.     

功能性腮腺切除术治疗腮腺深叶良性肿瘤

目的：探讨保存功能性外科在腮腺深叶肿瘤切除术中的应用及疗效。方法：17例腮腺深叶良性肿瘤患者,其中位于深叶者12例,累及浅深2叶者5例,直径均≤3 cm。采用制备筋膜腺体瓣并预留出将要切除的肿瘤及周围腺体的方法,完整切除腮腺深叶及肿瘤同时保存腮腺浅叶功能。结果：全部患者的手术均顺利完成,创口均Ⅰ期愈合,无涎瘘,外形满意;暂时性面瘫发生2例（11．76％）。17例均获随访,随访时间6～24个月,平均11个月。未见肿瘤复发;面瘫基本消失。结论：应用功能性腮腺切除术治疗腮腺深叶良性肿瘤能有效保存腺体功能,减少面部凹陷畸形及味觉出汗综合征等并发症。     

腮腺浅叶良性肿瘤区域性和浅叶切除临床研究

目的    观察腮腺浅叶良性肿瘤区域性切除术和浅叶切除术的疗效及并发症发生率,为合理选择术式提供依据。 方法    回顾性分析2001年1月至2008年12月焦作市第二人民医院口腔科收治的68例腮腺浅叶良性肿瘤患者病历资料,其中腮腺区域性切除术38例,腮腺浅叶切除术30例。随访2 ~ 5年,记录肿瘤复发、面瘫、Frey综合征和涎瘘的发生例数。对所得数据进行分析。结果    随访2~5年,所有患者均未复发。腮腺区域性切除术后并发症发生率13.15%,传统腮腺浅叶切除术为66.67%。结论    腮腺区域性切除术可作为体积较小的腮腺浅叶良性肿瘤治疗的首选术式,具有手术创伤小、并发症少及肿瘤复发率低等优点。     

隐蔽切口入路内镜辅助颈部肿物切除效果初探

目的探索评价颌面部隐蔽切口入路内镜辅助下颈部良性肿瘤切除的新术式。方法选取2018年1月至2019年8月于山东大学齐鲁医院口腔颌面外科就诊的颈部良性肿瘤患者17例(颏下区3例,下颌下区2例,腮腺后下极9例,胸锁乳突肌上区1例,胸锁乳突肌中区1例,胸锁乳突肌下区1例)。术前行CT检查,评价肿瘤大小、边界、形态、性质,根据肿瘤所在区域设计不同部位隐蔽切口,颏下区及下颌下区肿物选用口内前庭沟入路,腮腺后下极及胸锁乳突肌区肿物选用耳后隐蔽小切口入路。术中采用自制的"口腔手术用造腔装置"辅助牵拉完成颈部"造腔",内镜辅助下将肿物完整摘除,术后每3个月定期随访。结果所有手术均按预期完成,术后3个月复查时,视觉模拟量表平均为9.3分,患者对切口设计及手术整体效果均表示满意,术后1~15个月随访均未见复发。结论采用隐蔽切口入路内镜辅助颈部良性肿物切除是一种切口不明显、具有良好美容效果的手术方法。