52例腮腺区神经鞘瘤临床治疗及预后分析

doi:10.19439/j.sjos.2018.04.015

上海口腔医学 ›› 2018, Vol. 27 ›› Issue (4): 411-414.doi: 10.19439/j.sjos.2018.04.015

52例腮腺区神经鞘瘤临床治疗及预后分析

高明华^1,*, 尹雪莱^2,*, 胡永杰², 盛美春¹, 王忠华¹, 郑重阳¹, 张新宇², 吴海威²

1. 浙江省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;

收稿日期:2018-03-26 修回日期:2018-04-23 出版日期:2018-08-25 发布日期:2018-10-09
通讯作者: 胡永杰,E-mail： drhuyongjie@126.com
作者简介:高明华（1989-）,男,学士,住院医师,E-mail：406024200@qq.com;尹雪莱（1983-）,女,博士,主治医师,E-mail： yinxuelai@sina.com。^*并列第一作者

Clinical treatment and prognosis of 52 cases of neurinoma in parotid region

GAO Ming-hua¹, YIN Xue-lai², HU Yong-jie², SHENG Mei-chun¹, WANG Zhong-hua¹, ZHENG Chong-yang¹, ZHANG Xin-yu², WU Hai-wei²

1. Department of Oral and Maxillofacial Surgery, The 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, China

Received:2018-03-26 Revised:2018-04-23 Online:2018-08-25 Published:2018-10-09

摘要/Abstract

摘要： 目的: 探讨腮腺区神经鞘瘤的临床特点,并对其诊断、治疗及预后进行分析。方法: 收集2000年6月—2013年12月上海交通大学附属第九人民医院口腔颌面-头颈肿瘤科收治的52例腮腺区神经鞘瘤病例,分析患者临床特点、影像学检查、诊断、治疗及预后,采用SPSS13.0软件包进行Fisher精确检验。结果: 9例术前有面瘫、不适等神经症状,占17.31%。术前确诊率为21.15%,52例患者均行手术治疗并经病理学检查确诊。术后随访42 ~206个月,未发现肿瘤复发及恶变。28例患者术后出现不同程度面神经损伤症状,占53.85%;10例患者损伤症状消失,8例患者不同程度改善,占64.29%。当肿瘤与面神经无明显关联时,手术治疗有效率为100%;当肿瘤位于面神经上时,切除术总有效率为22.22%,囊内摘除术总有效率为85.71%,切除且同期重建总有效率为85.71%,差异具有统计学意义。结论: 腮腺区神经鞘瘤的术前确诊较难,确诊依赖病理诊断。该肿瘤需行手术治疗,术中应注意保护面神经,首选囊内摘除术;但当面神经离断及切除时,应尽可能同期行神经重建术,以期恢复患者面神经功能。

关键词: 腮腺, 神经鞘瘤, 面神经损伤

Abstract: PURPOSE: To investigate the clinical features, diagnosis, and treatment, as well as prognosis of neurinoma in parotid region, in order to provide references for clinical treatment. METHODS: Fifty-two cases of neurinoma in parotid region treated between June 2000 to December 2013 were retrospectively investigated, including their clinical characteristics, imaging examination, diagnosis, therapies and prognosis. SPSS13.0 software package was used for Fisher's exact test. RESULTS: Nine cases (17.31%) in all had facial paralysis, discomfort and other neural symptoms before operation. Eleven cases(21.15%) was preoperatively diagnosed. All patients were treated with surgery, pathologically diagnosed and followed up for 42 months to 206 months. No recurrence and malignant transformation were found. Twenty-eight cases (53.85%) had symptoms of facial nerve injury postoperatively, but 18 cases (64.29%) were improved functionally. When there was no obvious correlation between the tumor and facial nerve, no facial nerve paralysis was found. When the tumor was located on the facial nerve, the rate of preserving facial nerve function was 22.22%, the rate of intracapsular enucleation of the neurinoma was 85.71%, and the effective rate of excision followed by facial nerve reconstruction was 85.71%. CONCLUSIONS: The diagnosis of neurinoma in parotid region is difficult and needed to be confirmed by postoperative pathology. The preservation of facial nerve function should be the utmost procedure during operation while intracapsular enucleation is the first choice. However, in order to restore the function of facial nerve, nerve reconstruction should be performed as soon as possible.

Key words: Parotid gland, Neurinoma, Facial nerve injury

中图分类号:

R739.8

高明华, 尹雪莱, 胡永杰, 盛美春, 王忠华, 郑重阳, 张新宇, 吴海威. 52例腮腺区神经鞘瘤临床治疗及预后分析[J]. 上海口腔医学, 2018, 27(4): 411-414.

GAO Ming-hua, YIN Xue-lai, HU Yong-jie, SHENG Mei-chun, WANG Zhong-hua, ZHENG Chong-yang, ZHANG Xin-yu, WU Hai-wei. Clinical treatment and prognosis of 52 cases of neurinoma in parotid region[J]. Shanghai Journal of Stomatology, 2018, 27(4): 411-414.

参考文献

[1] 邱蔚六, 张震康, 张志愿, 等. 口腔颌面外科学 [M]. 第6版. 北京: 人民卫生出版社, 2008: 2-270.
[2] Rajabi MT, Riazi H, Hosseini SS, et al.Malignant peripheral nerve sheath tumor of lacrimal nerve: a case report[J]. Orbit (Amsterdam, Netherlands), 2015, 34(1): 41-44.
[3] Chong KW, Chung YF, Khoo ML, et al.Management of intraparotid facial nerve schwannomas[J]. Aust N Z J Surg, 2000, 70(10): 732-734.
[4] Ibartz PL.Rare kinds of parotid tumors[J]. An Fac Med (Montevideo),1927,12: 546.
[5] O'Keefe JJ.Neurinoma of the facial nerve in the parotid gland[J]. Ann Otol Rhinol Laryngol, 1949, 58(1): 220-225.
[6] Merker VL, Esparza S, Smith MJ, et al.Clinical features of schwannomatosis: a retrospective analysis of 87 patients[J]. Oncologist, 2012, 17(10): 1317-1322.
[7] Oberman HA, Sullenger G.Neurogenous tumors of the head and neck[J]. Cancer, 1967, 20(11): 1992-2001.
[8] Terasaki K, Mera Y, Uchimiya H, et al.Plexiform schwannoma[J]. Clin Exper Dermatol, 2003, 28(4): 372-374.
[9] Marchioni D, Alicandri Ciufelli M, Presutti L.Intraparotid facial nerve schwannoma: literature review and classification proposal[J]. J Laryngol Otol, 2007, 121(8): 707-712.
[10] 柏宁野, 戴光华, 郑辉. 外周神经源肿瘤的声像图诊断与鉴别诊断分析[J].中国超声医学杂志, 2001, 17(4): 309-311.
[11] 曾炜, 王弘士, 朱世亮, 等.颈部颈丛和臂丛神经鞘瘤的彩色多普勒超声定位诊断[J].中国超声医学杂志, 2000, 16(11): 819-822.
[12] Lee YYP, Wong KT, King AD, et al.Imaging of salivary gland tumors[J]. Eur J Radiol, 2008, 66(3): 419-436.
[13] Martin N, Sterkers O, Mompoint D, et al.Facial nerve neuromas: MR imaging. Report of four cases[J]. Neuroradiology, 1992, 34(1): 62-67.
[14] Suh JS, Abenoza P, Galloway HR, et al.Peripheral (extracranial) nerve tumors: correlation of MR imaging and histologic findings[J]. Radiology, 1992, 183(2): 341-346.
[15] Henrys CE, Grigg R.Use of fine-needle aspiration cytology in the diagnosis of parotid neoplasms[J]. ANZ J Surg, 2015, 85(11): 838-842.
[16] Gross BC, Carlson ML, Moore EJ, et al.The intraparotid facial nerve schwannoma: a diagnostic and management conundrum[J]. Am J Otolaryngol, 2012, 33(5): 497-504.
[17] Chung JW, Ahn JH, Kim JH, et al.Facial nerve Schwannomas: different manifestations and outcome[J]. Surg Neurol, 2004, 62(3): 245-252.
[18] Richmon JD, Wahl CE, Chia S.Coexisting facial nerve Schwannoma and monomorphic adenoma of the parotid gland[J]. Ear Nose Throat J, 2004, 83(3): 166-169.
[19] Gupta RK, Dowle CS.A case of neurilemoma (schwannoma) that mimicked a pleomorphic adenoma (an example of potential pitfall in aspiration cytodiagnosis)[J]. Diagn Cytopathol, 1991, 7(6): 622-624.
[20] Maly B, Maly A, Doviner V, et al.Fine needle aspiration biopsy of intraparotid schwannoma. A case report[J]. Acta Cytol, 2003, 47(6): 1131-1134.
[21] Guzzo M, Ferraro L, Ibba T, et al.Schwannoma in the parotid gland. Experience at our institute and review of the literature[J]. Tumori, 2009, 95(6): 846-851.
[22] Liu R, Fagan P.Facial nerve schwannoma: surgical excision versus conservative management[J]. Ann Otol Rhinol Laryngol, 2001, 110(11): 1025-1029.
[23] Sarela AI, Bapat VN, Supe AN.Intra-parotid neurilemmomas of the facial nerve[J]. Br J Oral Maxillofac Surg, 1997, 35(1): 71.
[24] Ulku CH, Uyar Y, Acar O, et al.Facial nerve schwannomas: a report of four cases and a review of the literature[J]. Am J Otolaryngol, 2004, 25(6): 426-431.
[25] House JW, Brackmann DE.Facial nerve grading system[J]. Otolaryngol Head Neck Surg, 1985, 93(2): 146-147.

52例腮腺区神经鞘瘤临床治疗及预后分析

Clinical treatment and prognosis of 52 cases of neurinoma in parotid region

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