腮腺良性肿瘤手术治疗的回顾性分析

发布时间：2019-02-23 16:54

【摘要】：研究目的：回顾58例腮腺良性肿瘤患者的临床治疗资料及复查随访资料，了解腮腺肿瘤及部分腺体切除术的手术方法及治疗效果，探讨两种面神经解剖方法的优缺点，及面神经总干的暴露和手术技巧，为腮腺良性肿瘤的临床治疗提供一定的临床依据。研究方法：收集2011年12月~2013年8月期间因腮腺肿物就诊于山西医科大学第一医院口腔颌面外科最后病理确诊为腮腺良性肿瘤的58例患者资料。这部分患者均采用腮腺肿瘤及部分腺体切除术，术中采用总干法或分支法两种不同的面神经解剖方法。在面神经总干法解剖过程中，9例患者保留耳大神经后支，其余49例患者术中切断耳大神经以利于S切口翻瓣。通过术后3个月、6个月门诊复查，记录患者术区愈合情况、并发症的发生及恢复情况。整理数据，采用SPSS13.0进行数据统计分析。研究结果： 58例患者均为腮腺良性肿瘤，其中主要为多形性腺瘤36例（62.1%）、腺淋巴瘤17例（29.3%），术后腺体均未出现分泌功能障碍，4例患者出现Frey’s综合征，局部涂抹药膏后症状缓解，5例患者术后2周内出现腮腺涎漏，经局部穿刺加压包扎恢复正常。肿瘤位于耳屏前，颧支损伤率为12.5%。肿瘤位于耳垂下，下颌缘支损伤率为23.5%，颊支损伤率为5.9%。肿瘤位于腮腺前下极，下颌缘支损伤率为37.5%。采用面神经总干法解剖35例，面神经损伤率为28.6%，面神经分支法解剖23例，面神经损伤率为30.4%。术后3~6个月患者面神经损伤有明显恢复。术后3个月后，58例患者中，7例术中保护耳大神经后支的患者耳垂及耳周皮肤有明显感觉，10例患者自觉麻木范围减小，其余患者均无明显感觉。术后6个月后，，9例术中保护耳大神经后支的患者耳垂及耳周皮肤均有明显感觉，19例患者自觉麻木范围减小。研究结论： 1、对于腮腺良性肿瘤，采用腮腺部分腺体及肿瘤切除术可以取得较好的治疗效果。 2、面神经功能受损情况与肿瘤位置、肿瘤大小及手术方式等有密切的关系，根据肿瘤位置、大小，采用适当的面神经解剖方法可以减少面神经损伤。 3、术中保护耳大神经后支，对耳区局部感觉功能的恢复有重大意义。
[Abstract]:The purpose of the study: The clinical treatment data and follow-up data of 58 cases of parotid benign tumor were reviewed. The operative method and treatment effect of parotid gland tumor and partial gland resection were reviewed. The advantages and disadvantages of the two methods of facial nerve were discussed. It is a coincidence that a certain clinical value is provided for the clinical treatment of the parotid benign tumor. According to. Research Methods: From Dec. 2011 to Aug. 2013, 58 cases of parotid gland tumor were diagnosed as parotid gland tumor in the first hospital of Shanxi Medical University. In this part of the patients, parotid tumors and partial glandular resection were used, and the total dry or branch method was used in the operation for two different surface gods. In the process of the total dry-process of the facial nerve, 9 patients retained the posterior branch of the ear, and the remaining 49 patients had the nerve to be cut off in the operation. S-incision flap. After 3-month and 6-month out-patient review, the healing of the patient's operation area and the occurrence of complications were recorded. and recovery. The data is sorted and the number of SPSS13.0 is used. According to the statistical analysis The results of the study: 58 patients were parotid benign tumors, including 36 (62.1%) of pleomorphic adenoma, 17 (29. 3%) of adenomatoid lymphoma, no secretion dysfunction in the gland, and 4 patients. Frey's syndrome, local application of the ointment to relieve the symptoms, 5 cases of the parotid salivary leak in 2 weeks after the operation, The puncture and pressure bandaging is normal. The tumor is located in front of the ear shield, The injury rate of the ramus was 12.5%. The injury rate of the lower jaw was 2.3. 5% in the ear lobe. The damage rate of the buccal branch was 50.9%. The tumor was located in the lower pole, the lower jaw and the lower part of the parotid gland. The injury rate of the marginal branch was 37. 5%. In 35 cases of the total dry method of the facial nerve, the damage rate of the facial nerve was 28. 6%, and the anatomy of the facial nerve branch was 23 cases. The rate of nerve injury was 30. 4%. The rate of nerve injury was 3 to 6 months after operation. There was a clear recovery of facial nerve injury. Among the 58 patients, after 3 months of operation, the ear lobe and the ear circumference of the patients with the large nerve in 7 of the 58 patients had a clear sensation in the ear lobe and the ear, and 10 patients had a sense of numbness. No significant difference was found in the rest of the patients. After 6 months of operation, the ear lobe and the skin of the ear and the ears of the patients with the large and middle ear of the ear were obviously felt after 6 months of operation. 19 patients The results of the study were as follows: 1. For the benign tumor of parotid gland, the gland of the parotid gland was used. and the function of the facial nerve is closely related to the position of the tumor, the size of the tumor, the operation mode and the like, The appropriate method of facial nerve dissection can reduce the facial nerve injury.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.8

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