腮腺手术中面神经监护的应用

发布时间：2019-02-20 21:16

【摘要】：目的:研究腮腺手术术中面神经监护的方法和特点,并评价其作用。方法:92例腮腺肿物患者分为术中监护组和对照组各46例,均采用腮腺肿物及部分腺体切除术+面神经解剖术,记录手术时间及术后面神经功能。监护组术中采用4导联实时监护,通过直接电刺激和自由肌电图辅助定位面神经,对照组术中不行面神经监护。结果:13例原发肿瘤患者(监护组6例,对照组7例)术中面神经分支与肿瘤无关,监护组手术时间为(50.0±9.1)min,对照组手术时间为(42.9±5.2)min(P=0.064)。65例原发肿瘤患者(监护组32例,对照组33例)术中需要解剖分离面神经,监护组手术时间为(74.7±28.0)min,对照组为(75.6±29.8)min(P=0.893)。复发肿瘤患者14例,监护组8例,手术时间为(117.5±37.8)min;对照组6例,手术时间为(175±47.8)min,监护组手术时间较对照组明显缩短(P0.05)。92例患者中,监护组8例出现面瘫症状,均因为肿瘤原因;对照组6例出现面瘫症状,4例因为肿瘤原因,2例为手术误伤。结论:术中面神经监护是辅助辨认和保护面神经的有效方法,应用术中神经监护能够降低复发腮腺肿瘤的手术时间,降低术中误伤神经风险,但不能明显降低术后面瘫的发生率。
[Abstract]:Objective: to study the methods and characteristics of facial nerve monitoring during parotid gland operation and evaluate its effect. Methods: 92 patients with parotid gland mass were divided into two groups: intraoperative monitoring group (n = 46) and control group (n = 46). In the monitoring group, the facial nerve was located by direct electrical stimulation and free electromyography, but not by the monitoring of the facial nerve in the control group. Results: 13 patients with primary tumor (6 cases in the monitoring group and 7 cases in the control group) had no relationship with the tumor during the operation. The operative time of the monitoring group was (50.0 卤9.1) min,. The operative time of the control group was (42.9 卤5.2) min (P0. 064). 65 patients with primary tumor (32 patients in the monitoring group and 33 patients in the control group) needed to dissect and separate the facial nerve during operation. The operative time in the monitoring group was (74.7 卤28.0) min,. The control group was (75.6 卤29.8) min (P < 0. 893). There were 14 cases of recurrent tumor and 8 cases of monitoring group. The operative time was (117.5 卤37.8) min;. In the control group (6 cases), the operation time was (175 卤47.8) min, monitoring group was significantly shorter than that in the control group (P0.05). Among 92 patients, 8 patients in the monitoring group had facial paralysis symptoms, all of them were caused by tumor. In the control group, 6 cases developed facial paralysis, 4 cases were caused by tumor and 2 cases were injured by operation. Conclusion: intraoperative facial nerve monitoring is an effective method for the identification and protection of facial nerve. Intraoperative nerve monitoring can reduce the operative time of recurrent parotid tumors and reduce the risk of nerve injury during operation. However, the incidence of postoperative facial paralysis could not be significantly reduced.
【作者单位】：北京大学口腔医学院·口腔医院口腔颌面外科;
【分类号】：R739.87

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