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。

Sixty-two cases report of surgical treatment of parotid pleomorphic adenoma

Objective To define the most appropriate surgical modality for parotid pleomorphic adenoma (PPA). Methods Sixty-two cases with PPA who underwent surgical treatment from January 1996 and December 2003 were reviewed retrospectively. The course of disease before treatment, tumor size, surgical modality, post-operative histopathological findings, recurrence and the complications were analyzed. Results There have been no recurrence in all 44 patients operated by superficial parotidectomy (SP), in all 16 patients operated by partial superficial parotidectomy plus partial deep parotidectomy (PSP+PDP), and in all 2 cases operated by total parotidectomy (TP). Pathological findings showed that in 6 cases (10%) the capsule of PPA was incomplete in focal areas and leaded to instances of positive margins, and in 28 cases (45%) the proliferation and mitosis were found in tumor cells with capsule invasion. 2 cases (4.5%) treated by SP had transient facial nerve dysfunction, while none of the 16 cases treated by PSP+PDP had facial nerve dysfunction. Frey syndrome occurred in 8 cases (18%) treated by SP, in 2 cases (13%) treated by PSP+PDP and in all 2 cases (13%) treated by total parotidectomy. The total rate of Frey syndrome in all 62 cases was 19.3%. Conclusions For the superficial PPA smaller than 4 cm, surgical procedure of PSP+PDP is as efficacy as SP, with relatively lower rates of complications like facial nerve dysfunction and Frey syndrome.