电缆状耳大神经移植修复腮腺癌切除术后面神经缺损

发布时间：2018-06-14 19:39

  本文选题：耳大神经 + 移植　； 参考：《临床耳鼻咽喉头颈外科杂志》2017年16期

【摘要】：目的:探讨采用电缆状耳大神经即刻移植修复腮腺癌切除术后面神经缺损的可行性。方法:因腮腺癌切除面神经后采用电缆状耳大神经移植即刻重建面神经患者11例,其中黏液表皮样癌9例,腺样囊性癌2例,均行患侧腮腺全切+肿瘤累及段面神经干及分支切除+同期电缆状耳大神经修复重建+择区性颈淋巴结清扫术。面神经缺损分为面神经干及分支、颞面干及分支和颈面干及分支3个类型;术后记录患者面部肌肉运动状态对称性及行双侧面神经肌电图检测;House-Brackmann(H-B)面神经功能分级系统评价面神经功能恢复情况。8例患者术后接受50~65Gy放疗。术后随访8~36个月,平均12个月。结果:在拟修复的面神经功能区,7例患者获得满意的闭眼功能(7/7);5例患者可见明显的皱额(5/7);9例患者静态时可获得对称的口角和鼻唇沟(9/9);4例患者放疗后3个月,面神经功能仍有明显改善。9例患者获得H-B分级Ⅱ级、2例获得Ⅲ级的康复效果。H-B分级为Ⅱ级的9例患者患侧面神经肌电活动仍较健侧轻微减弱。结论:电缆状耳大神经移植能有效修复腮腺癌切除术后面神经缺损,可作为即刻面神经缺损重建的方法。腮腺区的游离神经移植可能不是术后放疗的禁忌证。
[Abstract]:Objective: to investigate the feasibility of repairing facial nerve defect after parotid carcinoma resection with cable auricular nerve. Methods: eleven cases of facial nerve were reconstructed with cable auricular nerve transplantation, including 9 cases of mucoepidermoid carcinoma and 2 cases of adenoid cystic carcinoma. All the patients underwent total resection of the parotid gland involving the segmental facial nerve trunk and branch excision and selective cervical lymph node dissection for the repair and reconstruction of the great auricular nerve. The defects of facial nerve were divided into three types: trunk and branch of facial nerve, temporal trunk and branch, cervical trunk and branch. After operation, the symmetry of facial muscle movement status was recorded and bilateral facial nerve electromyography was performed to evaluate the recovery of facial nerve function by House-Brackmannn H-B. eight patients were treated with 50,65Gy radiotherapy after operation. Postoperative follow-up ranged from 8 to 36 months (mean 12 months). Results: in 7 patients with facial nerve functional area to be repaired, 7 / 7 patients had satisfactory eye closure function. In 5 patients, 5 / 7 patients could get symmetrical angle of mouth and 9 / 9 of nasolabial sulcus in static state. 3 months after radiotherapy, 4 patients with 9 / 9 of nasolabial sulcus were treated with radiotherapy, and 3 months after radiotherapy, 5 / 7 / 7 / 7 of the patients could obtain symmetrical angle of mouth and 9 / 9 / 9 of nasolabial sulcus after radiotherapy. The facial nerve function was still significantly improved in 9 patients with H-B grade 鈪，

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