紧贴面神经的腮腺多形性腺瘤的临床病理特点及处理

目的:探讨紧贴面神经的腮腺多形性腺瘤的临床病理特点及其处理。方法:2000年9月至2010年8月间在北京大学口腔医院手术治疗的20例(21侧)腮腺多形性腺瘤患者,术中发现面神经与肿瘤紧贴,分离、保留面神经后行肿瘤及腮腺切除,病理观察与面神经紧贴部位的肿瘤包膜结构,术后随访观察有无肿瘤复发。结果:21侧与面神经紧贴的肿瘤均有完整包膜,其中5侧包膜菲薄但完整;3侧包膜内有肿瘤结节浸润,但未突出包膜。术中1侧肿瘤破裂,术后2.5年出现种植性复发,其余20侧术中未发生肿瘤破裂,经平均4.5年随访,均未出现肿瘤复发。结论:与面神经紧贴的腮腺部位多形性腺瘤有菲薄但完整的包膜,细致分离并保留面神经是可行的,术中避免肿瘤破裂是预防种植性复发的关键。

Clinicopathologic characteristics and management of parotid pleomorphic adenomas closely abutting the facial nerve

Objective: To investigate the clinicopathologic characterstics and management of parotid pleomorphic adenomas closely abutting the facial nerve.Methods: Twenty cases(21 sides) of pleomorphic adenoma in the parotid gland were surgically treated in Peking University School and Hospital of Stomatology from September 2000 to August 2010.During the operation,the facial nerve was found to be closely abutted the tumor.The nerve was carefully dissected and preserved and the tumor was removed with the parotid gland.The capsular structure of the tumor in the location where the facial nerve closely abutted was examined histopathologically.The patients were followed after the treatment.Results: Complete capsule could be seen in the location of the tumor closely abutting the facial nerve.Very thin but complete capsule was shown in 5 cases and infiltrated tumor nodule within the capsule could be found in 3 cases.No recurrence of tumor occurred in the 20 sides without tumor spillage during the operation,while recurrence of tumor occurred in one patient with tumor spillage.Conclusion: There was thin but complete capsule in the location where facial nerve closely abutting the parotid pleomorphic adenoma,careful dissection and preservation of facial nerve was reliable.Avoiding spillage of the tumor during the operation was the key point to prevent the seeding recurrence of the tumor.