内镜辅助经下颌下入路腮腺深叶多形性腺瘤切除术

Resection of deeplobe parotid pleomorphic adenoma via endoscopic transsubmandibular approach

摘要:

摘要：目的探讨内镜辅助经下颌下入路切除腮腺深叶多形性腺瘤的可行性及疗效。方法采用内镜辅助经下颌下入路切除腮腺深叶多形性腺瘤7例，其中男2例，女5例，年龄36～65岁，平均年龄47岁。主要症状是吞咽异物感5例，咀嚼不适感2例；主要体征为发现患侧咽侧壁、软腭部膨隆6例，另1例无明显阳性体征。结果本组7例手术均在1.5～2.5 h内顺利完成，肿瘤获得完全切除，切口甲级愈合。且无腮腺区肿胀、声嘶、呛咳、呼吸及吞咽困难、伸舌偏斜发生，其中1例术后2 d出现患侧口角歪斜，约1个月后完全恢复。术后病理均为多形性腺瘤。随访时间6～38个月，平均为20个月。结论内镜辅助经下颌下入路可以完全、彻底切除腮腺深叶多形性腺瘤，既能保留面神经功能，又有助于同时保护颈部重要血管、神经，值得临床推广应用。

Abstract:

ObjectiveTo investigate the feasibility and curative effect of resection of deeplobe parotid pleomorphic adenoma via endoscopic transsubmandibular approach．MethodsThe surgical records and medical charts of 2 males and 5 females (age ranged from 36 to 65 years with a mean age of 47) diagnosed with pleomorphic adenoma of deeplobe parotid gland and operated via endoscopic transsubmandibular approach in our hospital between March 2016 and February 2019 were reviewed. As for the symptoms, 5 patients complained of throat indisposition, and the other 2 complained of chewing discomfort. Physical examination revealed bulge of lateral pharyngeal wall and soft palate at the affected?side in 6 patients．ResultsComplete removal of the tumor was achieved in all the 7 cases with the operative time from 1.5 h to 2.5 h. 6 patients were discharged without any complications such as parotid gland area swelling, facial palsy, coughing, hoarseness, breathing difficulty and dysphagia. Postoperative temporary facial palsy was observed in one patient and got improved after one month．All incisions healed at grade A. All patients had been followed up postoperatively for 6 to 38 months with an average of 20 months. Tumor recurrence occurred in none.ConclusionWith advantages of good safety, completeness and reservation of facial nerve function and protection of vital blood vessels and nerves, the simple endoscopic transsubmandibular approach is worth promoting in complete removal of deeplobe parotid pleomorphic adenoma.