腮腺面神经鞘瘤的诊断治疗

目的探讨腮腺中面神经鞘瘤临床特点、治疗方法。方法对11篇腮腺面神经鞘瘤相关文献及本院1例个案进行分析总结。结果68例腮腺面神经鞘瘤中，除腮腺区均有肿块外，自觉症状约占40％（27/68）：术前B超、CT及MRI均无明显诊断意义；术前腮腺穿刺阳性15％（2／13）；术前误诊86％（43／49，余19例未报）：术中快速冰冻病理切片基本均能确诊（29／30）；68例中（5例未报，术前面瘫5例，1例术后面瘫复发），术后39例不同程度周围性面神经瘫痪，占约69％（39／57）；包膜内切除瘤体24例，造成轻中重瘫痪15例，占约63％，术后6个月至7年随诊，中位数4年，只有4例恢复，其余不同程度恢复（Ⅳ级降为Ⅱ级）或残留永久性面瘫；肿瘤与面神经一同切除4例；术后随访30例，长达6个月～10年，中位数6年，未见肿瘤复发。结论腮腺中面神经鞘瘤临床上较罕见，治疗以外科为主。术前无特异性检查，术中快速冰冻病理检查具有显著的临床意义；术中应充分暴露肿瘤及面神经，尽量行包膜内切除瘤体，且不要盲目检查神经延续性，减少面神经损伤；一旦神经断离即行神经移植或标志神经断端为二期面神经吻合做准备，以尽快恢复或改善面神经功能；肿瘤术后复发可能性小。

Diagnosis and treatment of facial neurilemmoma in parotid region

OBJECTIVE To investigate the clinical features and management of facial neurilemmoma in parotid region.METHODS One case and 11 papers about facial neurilemmoma in parotid region were analyzed.RESULTS Only 40% (27/68)cases had symptoms except the mass in parotid region.The disease can not be diagnosed by Ultrasound B,CT and MRI.Thirteen cases underwent fine needle parotid biopsy and only 2 of them had positive results.Forty three of 49 cases(86%,19 cases had not been reported)were misdiagnosed preoperatively...