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目的探讨腮腺多形性腺瘤的临床诊断、手术方式的选择及术后复发和并发症的防治。方法对187例腮腺多形性腺瘤手术病例的临床资料进行分析,其中包膜外肿瘤切除+周围部分腮腺组织切除术86例,保留面神经的肿瘤切除+腮腺次全切除术72例,保留面神经的肿瘤切除+腮腺全切除术29例。结果术后肿瘤复发12例,经二次手术无再复发。术后发生暂时性面瘫20例,其中颊支面瘫6例,下颌缘支面瘫10例,颧支、颊支、下颌缘支面瘫者4例,经激素、神经营养药、中医理疗等处理,面神经麻痹超过6个月且不能完全恢复者为永久性面瘫。本组永久性面瘫2例;出现涎瘘15例,Frey综合征36例。结论腮腺多形性腺瘤的最后确诊必须依赖病理检查,以包膜外切除整个肿瘤,术中冰冻切片最为妥当,其手术方式的选择应根据肿瘤的大小、位置、与面神经的关系等来决定,术中面神经解剖是手术的关键,既能有效控制肿瘤的复发又能尽量避免并发症是手术的要点。
Objective To investigate the clinical diagnosis of parotid pleomorphic adenoma, surgical options and postoperative recurrence and complications prevention and treatment. Methods The clinical data of 187 cases of parotid pleomorphic adenoma were analyzed. Among them, 86 cases were excised by peritubular capsule + 86 cases were treated by parotid gland excision around the parietal region, 72 cases were resected with resection of parotidectomy and subtotal parotidectomy, Tumor resection + parotid total resection in 29 cases. Results Postoperative tumor recurrence in 12 cases, no recurrence after secondary surgery. There were 20 cases of temporary facial paralysis after surgery, including 6 cases of buccal and facial paralysis, 10 cases of mandibular facial paralysis, 4 cases of zygomatic branch, buccal branch and mandibular facial paralysis, hormone, neurotrophic drug and Chinese medicine treatment, facial nerve Those who paralyzed for more than 6 months and could not fully recover were permanent facial paralysis. This group of permanent facial paralysis in 2 cases; 15 cases of salivary fistula occurred, Frey’s syndrome in 36 cases. Conclusion The final diagnosis of parotid pleomorphic adenoma must rely on pathological examination to remove the entire tumor outside the capsule, the most appropriate intraoperative frozen section, the choice of surgical approach should be based on tumor size, location, and facial nerve relationship to decide, Intraoperative facial nerve anatomy is the key to surgery, both effective control of tumor recurrence and avoid complications as the main point of surgery.