腮腺复发性多形性腺瘤临床诊治分析（附67例）

目的:研究腮腺复发性多形性腺瘤的临床特点，总结其手术治疗经验。方法:对2010年6月至2018年6月期间我院收治的67例腮腺复发性多形性腺瘤病例进行回顾性分析，总结其临床病理特征、手术方式、术后并发症及随访情况，使用SPSS 22.0软件对数据进行χ2检验、t检验、Logistic回归分析。结果:40例初次手术行腮腺区肿物切除术者，其平均复发时间短于27例行腮腺浅叶切除或浅叶部分切除者［（17.18±5.39）个月 vs （20.89±6.63）个月，P＜0.05］。复发性多形性腺瘤可出现皮肤粘连（40.3%）、面神经粘连（73.1%）、多灶性病变（56.7%）、肿瘤包膜不完整（92.5%）以及镜下卫星结节（79.3%）等特征。主要的远期并发症为永久性面神经损伤(n=9,13.4%)及Frey综合征(n=18,26.9%)。随访期间术后再次复发7例，复发率13.0%，术中出现肿瘤破裂者，术后复发率较高（31.8% vs 0%，P＜0.05）。结论:腮腺多形性腺瘤初次肿物摘除术后复发常见，复发性肿瘤局部病变广泛，术后并发症常见，外科治疗应个体化，以腮腺浅叶切除为主，根据病变情况及患者意愿决定是否切除深叶；术中肿瘤破裂将增加术后复发风险，应尽量避免，术后还需密切随访。

Clinical diagnosis and treatment of 67 cases of recurrent pleomorphic adenoma of parotid gland

Objective:To study the clinical features of recurrent pleomorphic adenoma(RPA) of parotid gland,and to summarize the experience of its surgical treatment.Methods:67 cases of RPA of parotid gland treated in our hospital from June 2010 to June 2018 were retrospectively studied.Clinical and pathological features,surgical approach,complications and outcomes were summarized and statistical analyses were performed by statistical package SPSS 22.0.Results:40 cases underwent enucleation at the time of initial surgery,while 27 cases underwent superficial parotidectomy or partial superficial parotidectomy.The time to recurrence was (17.18±5.39)months and (20.89±6.63)months,respectively,and the difference was statistically significant(P＜0.05).Clinical features include dermal adhesions(40.3%),facial nerve adhesions(73.1%),multinodular lesions(56.7%),incomplete capsule(92.5%) and microscopic satellite nodules(79.3%) were found in these cases of RPA.The main long-term complications were permanent facial nerve dysfunction(n=9,13.4%) and Frey's syndrome(n=18,26.9%).7 cases(13.0%) recurred during follow-up.In the cases who complicating intraoperative tumor rupture,the recurrence rate was higher than those who did not complicating this feature,the difference was statistically significant(31.8% vs 0%,P＜0.05).Conclusion:RPA of parotid gland is most common in cases who underwent enucleation at the time of initial surgery,and it usually complicating widespread local lesions.Surgical approach should be individualized,based on superficial parotidectomy,and decide whether to remove the deep lobe according to the features of the tumors.Intraoperative tumor rupture may increase the risk of recurrence,so close follow-up is necessary for the patients who complicating this feature.