本文關(guān)鍵詞： 腮腺多形性腺瘤 手術(shù) 復(fù)發(fā) 并發(fā)癥　出處：《大連醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:多形性腺瘤是最常見的唾液腺良性上皮性腫瘤之一。由于其特殊的組織學(xué)特點,上皮成分多者容易惡變?yōu)榘┣岸嘈涡韵倭?長期帶瘤生存,腫瘤有惡變的可能,因此腮腺多形性腺瘤的治療以手術(shù)為主。從對單純腫瘤剜除術(shù)的摒棄到腮腺淺葉切除術(shù)、部分腮腺淺葉切除術(shù)及包膜外切除術(shù)等術(shù)式的先后提出,腮腺淺葉多形性腺瘤的標(biāo)準(zhǔn)手術(shù)方式莫衷一是。本文通過回顧性分析了2010年1月-2015年2月大連醫(yī)科大學(xué)附屬第一醫(yī)院和附屬第二醫(yī)院口腔頜面外科收治的腮腺多形性腺瘤首診患者的資料,旨在比較腮腺淺葉切除術(shù)、部分腮腺淺葉切除術(shù)、包膜外切除術(shù)在治療腮腺多形性腺瘤中的復(fù)發(fā)率和術(shù)后并發(fā)癥方面是否存在差異,評估部分腮腺淺葉切除術(shù)和包膜外切除術(shù)的臨床實用性。資料與方法:研究納入所有2010年1月-2015年2月期間大連醫(yī)科大學(xué)附屬第一醫(yī)院和大連醫(yī)科大學(xué)附屬第二醫(yī)院口腔頜面外科收治的腮腺淺葉多形性腺瘤患者,符合納入排除標(biāo)準(zhǔn),進行腮腺淺葉切除術(shù)、部分腮腺淺葉切除術(shù)或包膜外切除術(shù)治療。收集其流行病學(xué)信息、腫瘤部位及大小、手術(shù)方式、手術(shù)安全緣范圍、術(shù)中面神經(jīng)暴露情況、腫瘤溢出情況、腫瘤包膜組織病理學(xué)特點、術(shù)后面神經(jīng)損傷等并發(fā)癥的發(fā)生情況等資料。對患者進行電話隨訪,統(tǒng)計術(shù)后腫瘤復(fù)發(fā)率及術(shù)后并發(fā)癥恢復(fù)情況。對上述治療進行統(tǒng)計學(xué)分析。結(jié)果:研究共納入222例患者,男女比1:1.4,平均年齡為45.0±16.1歲,腫瘤平均大小2.7±1.2cm;147例患者接受隨訪,隨訪率66.2%,隨訪時間平均37個月。隨訪病例中,16.3%行腮腺淺葉切除術(shù),45.6%行包膜外切除術(shù),38.1%行部分腮腺淺葉切除術(shù)。隨訪組術(shù)后總復(fù)發(fā)率為2.7%,三組復(fù)發(fā)率無顯著差異(P=0.820)。術(shù)后暫時性面癱的發(fā)生率為14.9%,腮腺淺葉切除術(shù)后面神經(jīng)損傷的發(fā)生率明顯高于部分腮腺淺葉切除術(shù)(P=0.033)與包膜外切除術(shù)(P=0.001),而后兩者之間無顯著差異(P=0.066)。三組均未見永久性面癱發(fā)生。腮腺淺葉切除術(shù)后的Frey綜合征及涎瘺的發(fā)生率明顯高于部分腮腺淺葉切除術(shù)(P=0.048,P=0.012)與包膜外切除術(shù)(P0.001,P0.001)。組織病理學(xué)檢查結(jié)果中,包膜不完整組術(shù)后復(fù)發(fā)率明顯高于包膜完整組(P=0.033)。術(shù)中腫瘤溢出組與非溢出組術(shù)后復(fù)發(fā)率無顯著差異(P=0.179);面神經(jīng)緊貼包膜并未顯著增加多形性腺瘤的復(fù)發(fā)風(fēng)險(P=0.194)。結(jié)論:對于腮腺淺葉多形性腺瘤而言,腮腺淺葉切除術(shù)、部分腮腺淺葉切除術(shù)與包膜外切除術(shù)的復(fù)發(fā)率相當(dāng);采用部分腮腺淺葉切除術(shù)和包膜外切除術(shù)有利于降低術(shù)后暫時性面癱、Frey綜合征以及涎瘺的發(fā)生率。多形性腺瘤包膜不完整是影響預(yù)后的重要因素,而術(shù)中腫瘤溢出及面神經(jīng)緊貼包膜并未顯著增加復(fù)發(fā)風(fēng)險。
[Abstract]:Objective: pleomorphic adenoma is one of the most common benign epithelial tumors of the salivary gland. Tumor has the possibility of malignant change, so the treatment of pleomorphic adenoma of parotid gland is mainly surgical, from the rejection of simple tumor enucleation to superficial lobectomy of parotid gland. Part of the superficial parotid lobectomy and extracapsulectomy were put forward successively. The standard surgical methods for parotid pleomorphic adenoma were different. The oral and maxillofacial features of the first affiliated Hospital and the second affiliated Hospital of Dalian Medical University from January 2010 to February 2015 were analyzed retrospectively. Data of patients with pleomorphic adenoma of parotid gland treated in our department. Objective to compare the recurrence rate and postoperative complications of superficial parotid lobectomy, partial superficial parotid lobectomy and extracapsular excision in the treatment of pleomorphic adenoma of parotid gland. To evaluate the clinical practicability of partial superficial lobectomy and extracapsular excision. Data and methods:. All patients with parotid superficial lobar pleomorphic adenoma treated in the first affiliated Hospital of Dalian Medical University and the second affiliated Hospital of Dalian Medical University from January 2010 to February 2015 were included in the study. According to the exclusion criteria, superficial parotid lobectomy, partial superficial parotid lobectomy or extracapsular resection were performed. The epidemiological information, tumor location and size, operation method and safe margin of operation were collected. The data of intraoperative facial nerve exposure, tumor overflow, histopathological characteristics of tumor capsule, occurrence of complications such as nerve injury after operation and so on. The patients were followed up by telephone. Statistics of postoperative recurrence rate and postoperative complications recovery. The above treatment was statistically analyzed. Results: 222 patients were included in the study, the ratio of male and female was 1: 1.4. The mean age was 45.0 鹵16.1 years and the mean size of tumor was 2.7 鹵1.2 cm. 147 patients were followed up with a follow-up rate of 66.2 and an average follow-up time of 37 months. 16. 3% of the patients underwent superficial parotid lobectomy and 45. 6% underwent excision of parotid gland. 38.1% patients were treated with partial superficial parotid lobectomy. The total recurrence rate was 2.7 in the follow-up group. There was no significant difference in the recurrence rate among the three groups. The incidence of postoperative temporary facial paralysis was 14.9%. The incidence of nerve injury after superficial parotid lobectomy was significantly higher than that after partial superficial parotid lobectomy (P < 0.033) and extracapsular resection (P < 0.001). There was no significant difference between the latter two (P0. 066). The incidence of Frey syndrome and salivary fistula after superficial parotid lobectomy was significantly higher than that of partial superficial parotid lobectomy. P0. 012) and extracapsular excision (P0. 001) and P0. 001. histopathological findings. The postoperative recurrence rate in the incomplete capsule group was significantly higher than that in the intact capsule group (P 0.033). There was no significant difference in the postoperative recurrence rate between the tumor overflow group and the non-overflow group. Facial nerve clinging to the capsule did not significantly increase the risk of recurrence of pleomorphic adenoma P0. 194. Conclusion: for parotid superficial lobar pleomorphic adenoma, superficial parotid lobectomy. The recurrence rate of partial superficial parotid lobectomy was similar to that of extracapsular resection. Partial superficial parotid lobectomy and extracapsular excision can reduce the incidence of Frey's syndrome and salivary fistula after temporary facial palsy. The incomplete capsule of pleomorphic adenoma is an important factor affecting the prognosis. However, tumor spillover and facial nerve clinging to the capsule did not significantly increase the risk of recurrence.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R739.8

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