上海口腔医学

上海口腔医学 ›› 2019, Vol. 28 ›› Issue (4): 402-407.doi: 10.19439/j.sjos.2019.04.013

• 论著 • 上一篇    下一篇

超声刀辅助下腮腺良性肿瘤功能性包膜外切除术的临床效果评价

郑重阳1,*, 张新宇2,*, 曹锐3, 刘浏2, 胡永杰2   

  1. 1.湖州师范学院附属第一医院 口腔颌面外科,浙江 湖州 313000;
    2.上海交通大学医学院附属第九人民医院·口腔医学院 口腔颌面-头颈肿瘤科,上海 200011;
    3.常熟市第二人民医院 口腔颌面外科,江苏 常熟 215500
  • 收稿日期:2018-10-30 修回日期:2019-03-26 出版日期:2019-08-25 发布日期:2019-09-23
  • 通讯作者: 胡永杰, E-mail: drhuyongjie@126.com
  • 作者简介:郑重阳（1985-）,男,硕士,主治医师,E-mail：drzhengchongyang@163.com;张新宇（1989-）,男,硕士,住院医师,E-mail:zxyice@gmail.com。*并列第一作者
  • 基金资助:
    湖州市公益性应用研究项目(2017GY41)

Evaluation of harmonic scalpel assisted extracapsular dissection for benign parotid tumors

ZHENG Chong-yang1, ZHANG Xin-yu2, CAO Rui3, LIU Liu2, HU Yong-jie2   

  1. 1. Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Huzhou University. Huzhou 313000, Zhejiang Province;
    2. Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine. Shanghai 200011;
    3. Department of Oral and Maxillofacial Surgery, Second People's Hospital of Changshu. Changshu 215500, Jiangsu Province, China
  • Received:2018-10-30 Revised:2019-03-26 Online:2019-08-25 Published:2019-09-23

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摘要： 目的 探讨超声刀辅助下功能性包膜外切除术（harmonic scalpel assisted extracapsular dissection,HS-ECD）治疗腮腺良性肿瘤的临床效果。方法 回顾分析2013—2017年3家医疗机构使用HS-ECD术式进行治疗且资料齐全的132例腮腺良性肿瘤患者,根据肿瘤位置分为浅叶耳屏前、浅叶下极、腮腺深叶组,收集术中、围术期各项指标和并发症发生率,以及随访期内肿瘤复发率。采用SPSS 16.0软件包对数据进行统计学分析。结果 深叶组手术时间与术后引流时间较长,术中失血量与引流量较多（P<0.01）;深叶组面神经损伤概率较高（P=0.022）,耳大神经损伤、腮腺筋膜损伤及肿瘤包膜破裂3组间无显著差异（P>0.05）;深叶组术区皮肤感觉减退及涎瘘发生率较高(P=0.004、0.043);创口感染与味觉出汗综合征的发生率组间无显著差异（P>0.05）;深叶组暂时性面瘫发生率显著升高（P<0.01）,永久性面瘫发生率组间无显著差异（P=0.052）;肿瘤复发率3组间无显著差异（P=1.000）。结论 HS-ECD术式对腮腺良性肿瘤患者效果良好。术中切口缩小,组织损伤减轻;术后面型良好,功能保存完善,术后并发症发生率有效降低,肿瘤复发率控制良好。

关键词: 腮腺良性肿瘤, 功能性外科, 超声刀辅助下包膜外切除术, 术后并发症, 复发率

Abstract: PURPOSE: To investigate the clinical outcomes and prognosis of harmonic scalpel assisted extracapsular dissection for benign parotid tumors. METHODS: A total of 132 patients with full medical archives who were diagnosed as benign parotid tumors from 3 medical centers were retrospectively analyzed. The included patients were divided into 3 groups according to tumor positions, namely, superficial pre-auricular, superficial tail, and deep lobe. The intra- and peri-operative variables, complications, functional outcomes and recurrence rates were analyzed with SPSS 16.0 software package. RESULTS: The surgical and drainage time were longer and the blood loss and drainage amount were significantly greater in deep lobe group (P<0.01). Facial nerve damage occurred more frequently in deep lobe group (P=0.022), while damages of great auricular nerve and parotid fascia, as well as capsule rupture were similar among 3 groups (P>0.05). More patients with decreased sensation or sialocele were observed in deep lobe group (P=0.004, 0.043, respectively), and no significant differences were found for wound infection and Frey's syndrome among 3 groups (P>0.05). Transient facial nerve paralysis occurred more frequently in deep lobe group (P<0.01), while permanent facial nerve paralysis was similar (P=0.052). No significant difference was observed for tumor recurrence (P=1.000). CONCLUSIONS: HS-ECD displays good outcomes and prognosis for benign tumor of parotid gland, with improved esthetic and functional results as well as fewer complications and recurrence rate postoperatively.

Key words: Benign parotid gland tumor, Functional surgery, Harmonic scalpel assisted extracapsular dissection, Postoperative complication, Recurrent rate

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