腮腺浅叶多形性腺瘤的治疗策略

发布时间：2018-01-19 09:51

本文关键词： 腮腺多形性腺瘤手术复发并发症　出处：《大连医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:多形性腺瘤是最常见的唾液腺良性上皮性肿瘤之一。由于其特殊的组织学特点,上皮成分多者容易恶变为癌前多形性腺瘤,长期带瘤生存,肿瘤有恶变的可能,因此腮腺多形性腺瘤的治疗以手术为主。从对单纯肿瘤剜除术的摒弃到腮腺浅叶切除术、部分腮腺浅叶切除术及包膜外切除术等术式的先后提出,腮腺浅叶多形性腺瘤的标准手术方式莫衷一是。本文通过回顾性分析了2010年1月-2015年2月大连医科大学附属第一医院和附属第二医院口腔颌面外科收治的腮腺多形性腺瘤首诊患者的资料,旨在比较腮腺浅叶切除术、部分腮腺浅叶切除术、包膜外切除术在治疗腮腺多形性腺瘤中的复发率和术后并发症方面是否存在差异,评估部分腮腺浅叶切除术和包膜外切除术的临床实用性。资料与方法:研究纳入所有2010年1月-2015年2月期间大连医科大学附属第一医院和大连医科大学附属第二医院口腔颌面外科收治的腮腺浅叶多形性腺瘤患者,符合纳入排除标准,进行腮腺浅叶切除术、部分腮腺浅叶切除术或包膜外切除术治疗。收集其流行病学信息、肿瘤部位及大小、手术方式、手术安全缘范围、术中面神经暴露情况、肿瘤溢出情况、肿瘤包膜组织病理学特点、术后面神经损伤等并发症的发生情况等资料。对患者进行电话随访,统计术后肿瘤复发率及术后并发症恢复情况。对上述治疗进行统计学分析。结果:研究共纳入222例患者,男女比1:1.4,平均年龄为45.0±16.1岁,肿瘤平均大小2.7±1.2cm;147例患者接受随访,随访率66.2%,随访时间平均37个月。随访病例中,16.3%行腮腺浅叶切除术,45.6%行包膜外切除术,38.1%行部分腮腺浅叶切除术。随访组术后总复发率为2.7%,三组复发率无显著差异(P=0.820)。术后暂时性面瘫的发生率为14.9%,腮腺浅叶切除术后面神经损伤的发生率明显高于部分腮腺浅叶切除术(P=0.033)与包膜外切除术(P=0.001),而后两者之间无显著差异(P=0.066)。三组均未见永久性面瘫发生。腮腺浅叶切除术后的Frey综合征及涎瘘的发生率明显高于部分腮腺浅叶切除术(P=0.048,P=0.012)与包膜外切除术(P0.001,P0.001)。组织病理学检查结果中,包膜不完整组术后复发率明显高于包膜完整组(P=0.033)。术中肿瘤溢出组与非溢出组术后复发率无显著差异(P=0.179);面神经紧贴包膜并未显著增加多形性腺瘤的复发风险(P=0.194)。结论:对于腮腺浅叶多形性腺瘤而言,腮腺浅叶切除术、部分腮腺浅叶切除术与包膜外切除术的复发率相当;采用部分腮腺浅叶切除术和包膜外切除术有利于降低术后暂时性面瘫、Frey综合征以及涎瘘的发生率。多形性腺瘤包膜不完整是影响预后的重要因素,而术中肿瘤溢出及面神经紧贴包膜并未显著增加复发风险。
[Abstract]:Objective: pleomorphic adenoma is one of the most common benign epithelial tumors of the salivary gland. Tumor has the possibility of malignant change, so the treatment of pleomorphic adenoma of parotid gland is mainly surgical, from the rejection of simple tumor enucleation to superficial lobectomy of parotid gland. Part of the superficial parotid lobectomy and extracapsulectomy were put forward successively. The standard surgical methods for parotid pleomorphic adenoma were different. The oral and maxillofacial features of the first affiliated Hospital and the second affiliated Hospital of Dalian Medical University from January 2010 to February 2015 were analyzed retrospectively. Data of patients with pleomorphic adenoma of parotid gland treated in our department. Objective to compare the recurrence rate and postoperative complications of superficial parotid lobectomy, partial superficial parotid lobectomy and extracapsular excision in the treatment of pleomorphic adenoma of parotid gland. To evaluate the clinical practicability of partial superficial lobectomy and extracapsular excision. Data and methods:. All patients with parotid superficial lobar pleomorphic adenoma treated in the first affiliated Hospital of Dalian Medical University and the second affiliated Hospital of Dalian Medical University from January 2010 to February 2015 were included in the study. According to the exclusion criteria, superficial parotid lobectomy, partial superficial parotid lobectomy or extracapsular resection were performed. The epidemiological information, tumor location and size, operation method and safe margin of operation were collected. The data of intraoperative facial nerve exposure, tumor overflow, histopathological characteristics of tumor capsule, occurrence of complications such as nerve injury after operation and so on. The patients were followed up by telephone. Statistics of postoperative recurrence rate and postoperative complications recovery. The above treatment was statistically analyzed. Results: 222 patients were included in the study, the ratio of male and female was 1: 1.4. The mean age was 45.0 卤16.1 years and the mean size of tumor was 2.7 卤1.2 cm. 147 patients were followed up with a follow-up rate of 66.2 and an average follow-up time of 37 months. 16. 3% of the patients underwent superficial parotid lobectomy and 45. 6% underwent excision of parotid gland. 38.1% patients were treated with partial superficial parotid lobectomy. The total recurrence rate was 2.7 in the follow-up group. There was no significant difference in the recurrence rate among the three groups. The incidence of postoperative temporary facial paralysis was 14.9%. The incidence of nerve injury after superficial parotid lobectomy was significantly higher than that after partial superficial parotid lobectomy (P < 0.033) and extracapsular resection (P < 0.001). There was no significant difference between the latter two (P0. 066). The incidence of Frey syndrome and salivary fistula after superficial parotid lobectomy was significantly higher than that of partial superficial parotid lobectomy. P0. 012) and extracapsular excision (P0. 001) and P0. 001. histopathological findings. The postoperative recurrence rate in the incomplete capsule group was significantly higher than that in the intact capsule group (P 0.033). There was no significant difference in the postoperative recurrence rate between the tumor overflow group and the non-overflow group. Facial nerve clinging to the capsule did not significantly increase the risk of recurrence of pleomorphic adenoma P0. 194. Conclusion: for parotid superficial lobar pleomorphic adenoma, superficial parotid lobectomy. The recurrence rate of partial superficial parotid lobectomy was similar to that of extracapsular resection. Partial superficial parotid lobectomy and extracapsular excision can reduce the incidence of Frey's syndrome and salivary fistula after temporary facial palsy. The incomplete capsule of pleomorphic adenoma is an important factor affecting the prognosis. However, tumor spillover and facial nerve clinging to the capsule did not significantly increase the risk of recurrence.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R739.8

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