两种手术切口治疗腮腺肿瘤的对比研究

目的介绍一种腮腺肿瘤切除的改良式手术切口,并与传统方法进行临床对比。方法改良的腮腺切除术采用耳屏前面部除皱切口及耳后延续入发髻内切口,在嚼肌筋膜(SMAS)下翻瓣,减少了术后Frey综合征的发生;先解剖面神经总干减少了周围支的损伤,暴露面神经总干后,根据肿瘤的位置,选择性解剖面神经颈面干行腮腺部分切除术,保护腮腺的部分功能;采用蒂在上方的胸锁乳突肌填塞局部减少了术后畸形。结果应用传统术式的36例患者,38.8%出现面神经功能损害,16.2%出现涎瘘,8.3%出现Frey综合征;应用改良术式的6例患者中,无1例出现涎瘘及面神经损伤,随访3～6个月无1例出现Frey综合征,并且局部凹陷轻微,面容美观。结论改良式手术方法切口隐蔽,容易操作,不易损伤面神经周围支,术后并发症少。

Comparative study between modified technique of parotidectomy and traditional technique

Objective To describe a modified technique of parotidectomy and compare it with the traditional technique. Methods The modified technique includes using a face life incision to avoid the scar in the submandibular region, using the superficial musculoaponeurotic system (SMAS)as an interposing flap to interrupt the aberrant neural anatomies, facial nerve dissection from the main trunk to the peripheral branches, using a flap with an upper pedicle take from the sternocleidomastoid muscle to repair the defect after parotidectomy and using the technique of partial parotidectomy according to the size and location of the tumor. Results 6 patients were operated by using the modified technique and all the cases showed good aesthetic results with no obvious scar and deformity. 36 cases using the traditional technique showed 8.3% Frey's syndrome and 38.8% facial paralysis. Conclusion The modified technique of parotidectomy greatly reduces the disadvantages of the traditional technique. It can be used as a conventional technique.