摘要
目的探讨一种既能够有效根治肿瘤又能够最大限度保留患者颜面形态美观、腮腺腺体等生理功能的外科治疗术式,旨在为腮腺多形性腺瘤外科治疗术式的改良和优化、肿瘤患者生存质量的提高提供临床和病理依据。方法通过病例对照、结合病理学、免疫组织化学(比较传统手术和改良组患者术后肿瘤复发、并发症、肿瘤组织标本病理学特性发生率、深度及其相关因素)及Meta分析等研究方法。结果传统手术组与改良组肿瘤复发、面瘫、涎瘘发生率均无显著性差异。传统手术组Frey综合征、耳廓区麻木感、面部外形明显不对称的发生率在传统手术组高于改良组。肿瘤最大径小于2cm者26例：传统手术组的浸润深度为0.061～1.122mm,改良组的浸润深度为0.442～3.127mm(Z=-1.093,P=-0.057)；同理,2～4cm者67例,分别为0.081～7.908mm,0.082～6.632mm(Z=-O.214,P=0.831)；差异均无统计学意义。Meta分析显示外科治疗手段和胸锁乳突肌瓣可降低术后主、客观评价味觉出汗综合征及面部凹陷畸形的发生率。脱细胞真皮基质可降低主、客观评价的味觉出汗综合征的发生率,但不能降低面部凹陷畸形的发生率。结论与传统腮腺术式相比,改良组不增加复发率,且减少术后并发症的发生；改良组的安全手术切缘应根据肿瘤部位、大小等分类。小于4cm的肿瘤,其安全切缘为1cm,大于4cm的肿瘤行浅叶切除术。Meta分析显示通过外科手段可以减少腮腺切除术后味觉出汗综合征及面部凹陷畸形并发症的发生,改善患者术后的生存质量。
Objective To explore improvement methods not only can effectively eradicate a tumor, but alao can keep patients maximum facial form is beautiful, and physiological function of parotid glands, prevention of Frey syndrome and concave facial deformity after parotidectomy.
Methods Through the case control studies, combined with pathology, immunohistochemical (The occurrence rates of tumor recurrence, facial nerve paralysis, salivary fistula, Frey's syndrome, anaesthesia of auricular region and shape of the face were compared by different operation way.) and Meta analysis.Results The incidence of tumor recurrence, the facial paralysis and sialosyrinx were no significant difference between two groups. Frey's syndrome, the naesthesia of auricular region, and facial asymmetry in functional parotidectomy group were much lower than conventional group (all P<0.05). The depth of infiltration were no significant difference between two groups. Tumor smaller than2cm:the depth of infiltration in conventional group was from0.061to1.122mm, functional group was from0.442 to3.127mm (Z=1.785, P=0.074); tumors between2-4cm:the depth in conventional group was from0.081to7.908mm, functional group is from0.082mm to6.632mm (Z=-0.011, P=0.911). Meta-analysis for surgical techniques and the application of sternocleidomastoideus muscle flap can prevent symptomatic Frey syndrome, positive starch-iodine test results, The application of acellular dermal matrix decreased the incidence rates of symptomatic Frey syndrome and positive starch-iodine test, but did not decrease the incidence rates of contour deformity.Conclusions Compare with conventional operation group, functional parotidectomy has less complications. It is of valuable in clinical application. The surgical margins of pleomorphic adenomas of the parotid gland shoud be classified by the size of tumor. The surgical margins for all the tumors which are small than4cm are10mm, and the larger than4cm shoud use superficial parotidectomy. Meta-analysis of operative techniques to prevent symptomatic Frey syndrome, positive starchiodine test results, and facial asymmetry suggests that such methods are likely to reduce the incidence of these complications and improve the quality of life after parotidectomy
引文
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