异种脱细胞真皮基质预防腮腺术后味觉出汗综合征的临床研究
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摘要
目的
评价异种脱细胞异体真皮用于预防腮腺术后味觉出汗综合征的疗效,为进一步降低味觉出汗综合征的发病率提供经验教训,并提出最适合脱细胞真皮基质应用的适应症。
方法
2009年9月至2011年3月间浙医一院口腔科收治的42例腮腺良性病变患者,其中多形性腺瘤23例,淋巴组织增生(伴肉芽肿形成)7例,腺淋巴瘤5例,鳃裂囊肿2例,基底细胞腺瘤2例,肌上皮瘤1例,神经鞘瘤1例,脂肪组织瘤样增生1例。根据患者进入试验的时间早晚按计算机生成的随机顺序表分别进入试验组或对照组。试验组在腮腺浅叶切除或浅叶部分切除术后,根据缺损大小于腮腺咬肌筋膜瓣和剩余腮腺组织之间植入异种脱细胞真皮基质,对照组行腮腺浅叶切除或部分切除术。所有病例在术后3、6、12个月访视Frey综合征出现情况,通过Frey综合征调查表(FQC)进行主观评价,Minor碘淀粉试验进行客观评价。应用SPSS18.0统计软件包对所得数据进行卡方检验。
结果
所有病例于术后3、6、12个月进行随访,共有6人次失访。FQC问卷调查显示,试验组2/21例(9.52%)、对照组5/21例(23.81%)出现味觉出汗综合征主观症状,χ2=0.70,P=>0.05。Minor试验中,试验组3/21例(14.29%)、对照组11/21例(52.38%)出现Frey综合征客观症状,χ2=6.86,P=<0.01,有显著差异。术后6个月Frey综合征发病率对照组54.55%,试验组33.33%,χ2=6.72,P<0.05,有显著差异。所有病例未出现致敏等不良事件。
结论
腮腺浅叶部分切除或全部切除术中应用异种脱细胞异体真皮植入可以有效预防味觉出汗综合征,其主要作用体现在可以有效降低术后第6个月时Frey综合征发病率。
Objective
To evaluate the effectiveness of heterogeneous acellular dermal matrix as an interpositional grafe in prevention of Frey's syndrome after parotidectomy. Meanwhile, to provide experiences for further reducing the incidence of Frey's syndrome and propose the most appropriate indication of the acellular dermal matrix applications.
Method
We studied42patients with benign pathological changes in the parotid gland region who underwent superficial parotidectomy in our hospital from September2009to March2011. The baseline information was:23with pleomorphic adenoma,7with lymphadenosis,5with adenolymphoma,2with branchial cleft cyst,2with basal cell adenoma,1with myoepithelioma,1with Schwannoma and1with fat tissue tumor-like hyperplasia. They were divided into two groups randomly.21cases in control group underwent superficial parotidectomy or partial parotidectomy, while21cases in test group underwent insertion of acellular dermal matrix between the parotideomasseteric fascial flap and residual parotid tissues after superficial parotidectomy or partial parotidectomy. All the patients were required follow-ups3,6,12months after operation and did FQC questionnaire for subjective symptom and Minor's iodine starch test for objective symptom. SPSS18.0software package was used for Chi-square test.
Results
There were6losses of follow-ups in total. The FQC showed that2of21(9.52%) in test group,5of21(23.81%) in control group had subjective symptoms of Frey's syndrome. There was no significant differences(x2=0.70, P=>0.05). By Minor's starch iodine test, there were3(14.29%) in test group and11(52.38%) in control group that had objective symptoms. The difference between the two groups was significant χ2=6.86, P=<0.01). The incidence of Frey's syndrome6months after operation was33.33%to54.55%(test group to control group), the improvement was significant χ2=6.72, P<0.05).
Conclusions
Insertion of heterogeneous acellular dermal matrix is an effective method for prevention of Frey's syndrome after parotidectomy. It's major effectiveness is to lower the incidence6months after parotidectomy.
评价异种脱细胞异体真皮用于预防腮腺术后味觉出汗综合征的疗效,为进一步降低味觉出汗综合征的发病率提供经验教训,并提出最适合脱细胞真皮基质应用的适应症。
方法
2009年9月至2011年3月间浙医一院口腔科收治的42例腮腺良性病变患者,其中多形性腺瘤23例,淋巴组织增生(伴肉芽肿形成)7例,腺淋巴瘤5例,鳃裂囊肿2例,基底细胞腺瘤2例,肌上皮瘤1例,神经鞘瘤1例,脂肪组织瘤样增生1例。根据患者进入试验的时间早晚按计算机生成的随机顺序表分别进入试验组或对照组。试验组在腮腺浅叶切除或浅叶部分切除术后,根据缺损大小于腮腺咬肌筋膜瓣和剩余腮腺组织之间植入异种脱细胞真皮基质,对照组行腮腺浅叶切除或部分切除术。所有病例在术后3、6、12个月访视Frey综合征出现情况,通过Frey综合征调查表(FQC)进行主观评价,Minor碘淀粉试验进行客观评价。应用SPSS18.0统计软件包对所得数据进行卡方检验。
结果
所有病例于术后3、6、12个月进行随访,共有6人次失访。FQC问卷调查显示,试验组2/21例(9.52%)、对照组5/21例(23.81%)出现味觉出汗综合征主观症状,χ2=0.70,P=>0.05。Minor试验中,试验组3/21例(14.29%)、对照组11/21例(52.38%)出现Frey综合征客观症状,χ2=6.86,P=<0.01,有显著差异。术后6个月Frey综合征发病率对照组54.55%,试验组33.33%,χ2=6.72,P<0.05,有显著差异。所有病例未出现致敏等不良事件。
结论
腮腺浅叶部分切除或全部切除术中应用异种脱细胞异体真皮植入可以有效预防味觉出汗综合征,其主要作用体现在可以有效降低术后第6个月时Frey综合征发病率。
Objective
To evaluate the effectiveness of heterogeneous acellular dermal matrix as an interpositional grafe in prevention of Frey's syndrome after parotidectomy. Meanwhile, to provide experiences for further reducing the incidence of Frey's syndrome and propose the most appropriate indication of the acellular dermal matrix applications.
Method
We studied42patients with benign pathological changes in the parotid gland region who underwent superficial parotidectomy in our hospital from September2009to March2011. The baseline information was:23with pleomorphic adenoma,7with lymphadenosis,5with adenolymphoma,2with branchial cleft cyst,2with basal cell adenoma,1with myoepithelioma,1with Schwannoma and1with fat tissue tumor-like hyperplasia. They were divided into two groups randomly.21cases in control group underwent superficial parotidectomy or partial parotidectomy, while21cases in test group underwent insertion of acellular dermal matrix between the parotideomasseteric fascial flap and residual parotid tissues after superficial parotidectomy or partial parotidectomy. All the patients were required follow-ups3,6,12months after operation and did FQC questionnaire for subjective symptom and Minor's iodine starch test for objective symptom. SPSS18.0software package was used for Chi-square test.
Results
There were6losses of follow-ups in total. The FQC showed that2of21(9.52%) in test group,5of21(23.81%) in control group had subjective symptoms of Frey's syndrome. There was no significant differences(x2=0.70, P=>0.05). By Minor's starch iodine test, there were3(14.29%) in test group and11(52.38%) in control group that had objective symptoms. The difference between the two groups was significant χ2=6.86, P=<0.01). The incidence of Frey's syndrome6months after operation was33.33%to54.55%(test group to control group), the improvement was significant χ2=6.72, P<0.05).
Conclusions
Insertion of heterogeneous acellular dermal matrix is an effective method for prevention of Frey's syndrome after parotidectomy. It's major effectiveness is to lower the incidence6months after parotidectomy.
引文
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[2]Torretta S, Pignataro L, Capaccio S, et al. Fat injections for the management of post-parotidectomy Frey syndrome:a technical note. J Craniomaxillofac Surg, 2012.40(2):173-176.
[3]Steffen A, Rotter N, Konig I R, et al. Botulinum toxin for Frey's syndrome:a closer look at different treatment responses. J Laryngol Otol,2012.126(2):185-189.
[4]Glaser D A, The use of botulinum toxins to treat hyperhidrosis and gustatory sweating syndrome. Neurotox Res,2006.9(2-3):173-177.
[5]Tugnoli V, Marchese Ragona R, Eleopra R, et al. The role of gustatory flushing in Frey's syndrome and its treatment with botulinum toxin type A. Clin Auton Res, 2002.12(3):174-178.
[6]Steffen A, Rotter N, Konig I R, et al. Botulinum toxin for Frey's syndrome:a closer look at different treatment responses. J Laryngol Otol,2012.126(2):185-189.
[7]de Bree R, Duyndam J E, Kuik D J, et al. Repeated botulinum toxin type A injections to treat patients with Frey syndrome. Arch Otolaryngol Head Neck Surg,2009.135(3):287-290.
[8]Bakke M, Max Thorsen N, Bardow A, et al. Treatment of gustatory sweating with low-dose botulinum toxin A:a case report. Acta Odontol Scand,2006.64(3): 129-133.
[9]Wille-Bischofberger A, Rajan G P, Linder T E, et al. Impact of the SMAS on Frey's syndrome after parotid surgery:a prospective, long-term study. Plast Reconstr Surg,2007.120(6):1519-1523.
[10]Foustanos A, Zavrides H, Face-lift approach combined with a superficial musculoaponeurotic system advancement flap in parotidectomy. Br J Oral Maxillofac Surg,2007.45(8):652-655.
[11]杨茂进,柴鉴深,陈渝斌,等.重建腮腺嚼肌筋膜对预防Frey综合征的疗效观察[J].第三军医大学学报,2005,27(5)：440-442.
[12]Filho W Q, Dedivitis R A, Rapoport A, et al. Sternocleidomastoid muscle flap preventing Frey syndrome following parotidectomy. World J Surg,2004,28(4): 361-364.
[13]李冠斌,唐友盛.腮腺手术应用胸锁乳突肌瓣转移预防味觉出汗综合征的效果观察[J].广西医学,2002,24(1)：21-23.
[14]Zhao H W, Li L J, Han B, et al. Preventing post-surgical complications by modification of parotidectomy. Int J Oral Maxillofac Surg,2008.37(4): 345-349.
[15]Yu K, Yang J, Li MJ, et al. Clinical application of acellular dermal matrix to prevent gustatory sweating syndrome. Zhonghua Kou Qiang Yi Xue Za Zhi, 2007.42(9):570-571.
[16]Clayman M A, Clayman S M, Seagle M B, A review of the surgical and medical treatment of Frey syndrome. Ann Plast Surg,2006.57(5):581-584.
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