刘洪, 李超, 樊晋川, 王少新, 王薇, 张兵, 刘坤. 腮腺手术切除术中两种解剖方式对面神经功能的影响[J]. 中国肿瘤临床, 2014, 41(17): 1120-1124. DOI: 10.3969/j.issn.1000-8179.20140393
引用本文: 刘洪, 李超, 樊晋川, 王少新, 王薇, 张兵, 刘坤. 腮腺手术切除术中两种解剖方式对面神经功能的影响[J]. 中国肿瘤临床, 2014, 41(17): 1120-1124. DOI: 10.3969/j.issn.1000-8179.20140393
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LIU Hong, LI Chao, FAN Jinchuan, WANG Shaoxin, WANG Wei, ZHANG Bing, LIU Kun. Comparison of facial nerve injury and recovery rate after anterograde and retrograde nerve dissection of benign parotid tumor[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2014, 41(17): 1120-1124. DOI: 10.3969/j.issn.1000-8179.20140393
Citation: LIU Hong, LI Chao, FAN Jinchuan, WANG Shaoxin, WANG Wei, ZHANG Bing, LIU Kun. Comparison of facial nerve injury and recovery rate after anterograde and retrograde nerve dissection of benign parotid tumor[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2014, 41(17): 1120-1124. DOI: 10.3969/j.issn.1000-8179.20140393
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腮腺手术切除术中两种解剖方式对面神经功能的影响

Comparison of facial nerve injury and recovery rate after anterograde and retrograde nerve dissection of benign parotid tumor

    摘要
  • 摘要:
      目的  比较两种面神经解剖方法（顺行解剖和逆行解剖）在腮腺良性肿瘤中的安全性和优越性。
      方法  收集2011年1月至2013年1月四川省肿瘤医院头颈外科完成的病理诊断为腮腺良性腺瘤共110例，分别采用顺行法解剖（A组）52例，逆行法（B组）58例；其中将58例逆向解剖根据分支的优先解剖顺序分为颧支组（B1组）17例、颊支组（B2组）20例、下颌缘支组（B3组）21例。术后观察患者是否出现面神经瘫痪症状、严重程度、恢复情况。采用House-Brankmann（HB）面神经功能分级法进行评价。
      结果  A、B两组面神经解剖方法均能较好的暴露面神经，完整顺利的切除肿瘤。A组术后1周内评价在Ⅲ级及以上的面神经功能障碍共19例，B组术后1周内出现Ⅲ级及以上的面神经功能障碍共30例，两种解剖方式对面神经功能的影响差异有统计学意义（P < 0.05），且在面神经功能恢复方面差异有统计学意义（P > 0.05）。B1和B2组、B1和B3组面神经功能的影响差异无统计学意义（P > 0.05），B2和B3组面神经功能的影响差异有统计学意义（P < 0.05）。
      结论  顺向解剖与逆向解剖均能顺利的完成手术，顺向解剖对面神经功能的影响低于逆向解剖，在面神经功能的恢复方面优于逆向解剖；逆向解剖中，从颊支或者颧支开始解剖无论是在面神经功能的保护还是在面神经功能的恢复均优于下颌缘支，顺向解剖面神经在腮腺两性肿瘤中应优先选择，即使在不得不选择逆向解剖的情况下，应从颊支或者颧支解剖。

     

    Abstract:
      Objective  Facial nerves can be dissected using anterograde and retrograde approaches. The optimal technique for the facial nerve dissection of a patient with benign parotid tumor has not yet been determined. This study focused on facial nerve dysfunction and recovery rate after anterograde and retrograde facial-nerve dissections.
      Methods  The data of 110 patients with benign carotid adenoma from the Head and Neck Department of this hospital who were hospitalized between January 2011 and January 2013 were collected. These patients were divided into groups A (n=52) and B (n=58). Anterograde and retrograde dissections of the facial nerve were performed on group A and group B patients, respectively. Based on the preferential order of dissection, group B was divided into groups B1, B2, and B3 representing the zygomatic, buccal, and marginal mandibular branches, respectively. The patients were postoperatively observed to check for potential symptoms, such as facial paralysis along with its severity and recovery. The House-Brackmann grading system was used to assess all patients.
      Results  The operation could be successful, with better nerve exposure, using these approaches. Statistical differences were observed in the nerve injury and recovery rates between the groups, with group A better than group B, and group B2 better than the other two groups (P < 0.05).
      Conclusion  Anterograde facial nerve dissection should be routinely used in benign parotid tumor, and the buccal branch of facial nerve dissection should be preferentially considered when no other option apart from retrograde dissection is available.

     

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