腮腺手术中耳大神经后支保留的临床意义

目的 探讨腮腺手术中耳大神经后支保留的可行性、方法及临床价值。方法 我们对48例腮腺肿瘤患者，按常规隐蔽切口腮腺手术方法进行治疗，保留或不保留耳大神经后支。分别于术后10d及1、6、12个月进行随访，检测耳廓上部、耳垂、耳下区、耳前区和耳后区的触觉、痛觉，并观察其感觉变化情况。结果 48例中35例耳大神经后支保留，耳廓上部及耳后区感觉无减退。术后早期耳前、耳垂及耳下区感觉有不同程度的减退，以耳前区最明显，随着时间延长症状逐步好转，6个月时感觉接近正常。另13例耳大神经切断患者感觉减退症状更加明显，恢复时间延长。结论 腮腺手术中耳大神经后支保留是可行的，所采用的方法可靠，可减轻局部麻木感，提高患者术后早期生活质量，降低神经切断后产生局部永久性麻木的可能性。     

耳后隐蔽切口逆向解剖面神经在腮腺部分切除术中的临床应用

目的:探讨耳后隐蔽切口沿下颌缘支逆向解剖面神经在腮腺部分切除术中的临床疗效.方法:选取2015年1月-2018年1月收治的62例腮腺肿瘤患者进行观察,随机分为观察组和对照组,对照组采用传统\"S\"形手术方法,观察组采用耳后隐蔽切口沿下颌缘支逆向解剖面神经方法,术后对患者进行随访,比较两组术后面神经功能、手术并发症、切口瘢...     

腮腺肿瘤的美学切除技术研究进展

手术切除是腮腺肿瘤的重要治疗手段,减少神经损伤、预防术后并发症发生及疾病复发是手术治疗的关键.传统手术切口瘢痕明显,容易出现局部凹陷及味觉出汗综合征等美学问题.随着医疗技术的进步,颌面部外科手术在手术切口及切除技术等方面作了改进.本文将回顾腮腺肿瘤手术切除方法,介绍美学切除技术类型及其临床应用现状,为解决该病手术治疗中...     

耳后岛状皮瓣修复耳前肿物切除创面一例

患者女,63岁,于7年前(1998年)发现左耳廓对耳轮处约绿豆大小的褐色肿块,自认为是黑痣,未予以重视,后肿块缓慢增大,至近期增大成蚕豆大小,遂来院就诊,全病程中无疼痛及其它不适感。检查:一般情况良好,心肺正常,无慢性疾病史。左耳廓对耳轮中部1/3处见2cm×2cm大小的黑褐色肿块(图1),侵及耳轮内侧缘,高出皮面0.5cm,界线清楚,肿块表面粗糙,呈疣状增生,实性,质韧,无压痛。诊断:左耳廓脂溢性角化病。术后病理检查:脂溢性角化病。手术方法皮瓣设计:沿左颅耳沟方向为皮瓣纵轴,以该轴为中心向两侧各取1.3cm宽皮瓣,皮瓣蒂部在耳垂后方,皮瓣上缘平左耳…     

耳屏周小切口在腮腺良性肿瘤切除中的应用

【摘要】目的评估耳屏周小切口在腮腺良性肿瘤切除术中应用的临床价值。方法30例腮腺良性肿瘤患者,应用耳屏周小切口行浅叶部分切除、保留面神经和耳大神经的腮腺良性肿瘤切除术。术后随访3～24个月,观察耳屏周小切口的美观度及临床疗效。结果所有患者均临床Ⅰ期愈合,术后腮腺功能良好,无涎瘘发生。随访,患者双侧外形对称,无凹陷等畸形,手术切口隐蔽,患者对耳周切口美学效果满意。本研究中出现术后暂时性面瘫患者2例,皮质激素并配合神经营养药物综合治疗后3个月均恢复正常;出现术后耳垂麻木不适患者4例,手术后3～10个月均逐渐恢复。本研究中所有患者均未出现味觉出汗综合征,无肿瘤复发。结论耳屏周小切口隐蔽、瘢痕小、并发症低,术后美容效果理想。     

右下腹膜后逆行入路行右上腹巨大肿瘤切除技巧探讨

右上腹巨大肿瘤膨胀浸润性生长．容易侵及压迫十二指肠、胰腺和右半结肠及区域血管．按传统程序探查及切除有一定的难度。我们利用右下腹逆行腹膜后入路顺利切除有上腹巨大肿瘤3例,取得了较为满意的切除效果。现报告如下：     

腮腺肿瘤切除术的美容考虑与处理

目的:探讨小切口在腮腺良性肿瘤切除术中的临床应用、美学处理及利用腮腺残端组织修复组织缺损的方法。方法:选择肿瘤直径<2cm,发生在腮腺下极良性肿瘤患者32例,采用下颌升支后缘切口,解剖面神经下颌缘支及下颊支,保留腮腺导管,行腮腺肿瘤及区域性腮腺切除术,用腮腺残端组织瓣转移修复下颌后区组织缺损。结果:32例患者术后伤口愈合良好,随访2年,无术后复发及味觉出汗综合征患者,瘢痕短,局部凹陷不明显,无永久性面瘫发生。结论:针对发生在腮腺下极且直径<2cm的良性肿瘤,经小切口切除肿瘤,用腮腺残端组织转移修复缺损的手术方式,减少了手术创伤及并发症,改善局部组织凹陷,获得满意的手术效果和美学效果。     

改良S形切口入路腮腺切除术治疗腮腺肿瘤的美学效果研究

目的：探讨改良S形切口入路腮腺切除术治疗腮腺肿瘤的美学效果。方法：选取2018年1月-2021年1月就诊于笔者医院口腔颌面外科并行手术治疗的69例患者,其中34例采用改良“S”形切口入路腮腺切除术作为观察组,35例采用常规腮腺切除术作为对照组。采用视觉模拟量表评估术后美学效果和满意度;记录两组住院时间、手术时间及术中出血量;采用华盛顿大学生存质量问卷(University of Washington quality of life questionnaire,UW-QOL)对患者术后半年的生活质量进行评分;统计两组并发症发生率。结果：观察组美学效果和满意度评分高于对照组,差异有统计学意义(P<0.05)。两组手术时间、术中出血量比较差异无统计学意义(P>0.05);但观察组住院时间短于对照组,差异有统计学意义(P<0.05)。观察组术后情绪、疼痛、唾液、咀嚼、味觉各项生活质量评分均高于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率为8.82%低于对照组的28.57%,差异有统计学意义(P<0.05)。结论：改良“S”形切口入路腮腺切除术可提高...     

前入路与后外侧入路腹腔镜脾切除治疗区域性门静脉高压

目的 探讨经后外侧入路分离方式腹腔镜脾切除术治疗慢性胰腺炎所致区域性门静脉高压症的临床价值。 方法 回顾性分析2010年1月至2016年6月郑州大学人民医院收治的62例慢性胰腺炎所致区域门性静脉高压症行腹腔镜脾切除术的患者临床资料。根据分离方式不同,分为前入路组和后外侧入路组,比较两组相关指标的差异。 结果 前入路组和后外侧入路组患者的手术时间分别为(135.0±12.8)min与(126.0±13.1)min、术中非脾脏出血量分别为(323.7±50.9)ml与(245.1±35.0)ml、胃肠功能恢复时间分别为(25.5±2.5)h与(23.5±3.3)h、引流管拔除时间分别为(5.7±1.0)d与(3.2±1.3)d、术后住院时间分别为(9.3±1.5)d与(7.3±1.2)d。上述各项两组比较,差异均有统计学意义(均 P<0.05)。所有患者均获得随访,术后3个月复查所有患者食管、胃底静脉曲张情况,均显示明显改善或消失。至随访结束,所有患者恢复良好。 结论 经后外侧入路分离方式腹腔镜脾切除术有利于慢性胰腺炎所致区域性门静脉高压症的治疗,是一种值得推广的手术分离方式。     

医用生物蛋白胶在腮腺浅叶良性肿瘤切除术中的应用研究

目的:探讨医用生物蛋白胶在腮腺浅叶良性肿瘤切除术中的临床应用。方法:2006年1月~2011年6月来我院口腔颌面外科住院手术治疗的腮腺浅叶良性肿瘤患者50例,随机分为医用生物蛋白胶组(n=24)和对照组(n=26),术后从术区引流量、拔管时间、术区有无感染、面瘫、涎瘘及Frey综合征进行观察和评价。结果:两组患者均未发生切口感染,与对照组比较,医用蛋白胶组患者术后第1天和术后总引流量均明显减少,拔管时间提前,差异有统计学意义(P0.05)。医用蛋白胶组发生术后并发症的例数明显少于对照组(P0.05)。结论:在腮腺浅叶良性肿瘤切除术中应用医用生物蛋白胶可明显减少术后并发症的发生,并在一定程度上促进术后创口的愈合。     

Outcome of surgery for parotid tumours: 5-year experience of a general surgical unit in a teaching hospital

BACKGROUND: Most of the recent reports on the surgical management of parotid gland disorders come from specialist divisions of otolaryngology, head and neck, or faciomaxillary surgery. The aim of the present study was to evaluate the outcome of surgery for parotid tumours in a general surgical unit of a teaching hospital. METHOD: A prospective clinicopathological study was undertaken over a 5-year period for consecutive patients operated on for parotid gland tumours in the King Saud University Unit of Riyadh Medical Complex. Parameters analyzed were demographic details, clinical presentation, diagnostic work-up, type of surgery, and outcome in terms of early and late morbidity. RESULTS: Thirty seven parotid operations were performed on 36 consecutive patients. All patients presented with parotid gland swelling. Mean age was 51.6 years with a male preponderance. Fine-needle aspiration diagnosed the pathology in 33 out of 37 lesions. Pleomorphic adenoma was the commonest pathology observed in 24 patients (64.9%). Warthin's tumour was more common among male patients and was the only pathology with bilateral involvement. Malignant tumour was found in five patients (13.5%). Superficial conservative parotidectomy was the most frequently performed operation (84%). Overall postoperative morbidity was 13.5%. Transient facial nerve palsy was observed in seven cases (19%). There was no recurrence identified in patients with benign diseases during the mean follow up of 38.5 months. CONCLUSION: Parotid gland surgery can still be performed in a general surgery unit with comparable outcome. However, the operation should be performed in units with special interest and experience in surgery for parotid gland disorders.     

Recurrent pleomorphic adenoma of the parotid gland: analysis of 108 consecutive patients

BACKGROUND: Surgery for recurrent parotid pleomorphic adenoma is a challenging problem. METHODS: One hundred eight patients who underwent 134 reoperations for recurrent parotid pleomorphic adenoma (follow-up, 22 years) were evaluated for histopathologic features and risk factors for recurrence. RESULTS: The number of reoperations for tumor recurrence ranged from 1 to 10. Twenty-seven patients (25%) developed permanent facial nerve weakness. The risks for clinically evident rerecurrence after 1, 5, and 15 years were 16%, 42%, and 75%, respectively. Female sex, young age at initial treatment, and enucleation instead of parotidectomy for treatment of the first recurrence were significant risk factors for rerecurrence. The mean number of recurrent tumor nodules was 26. CONCLUSIONS: Surgery for recurrent parotid pleomorphic adenoma has a high rate of facial nerve morbidity. The chance of rerecurrence is high. Extended parotidectomy seems to be the best approach for the reoperation to reduce the risk of rerecurrence.     

The transzygomatic approach: A long-term clinical review

Summary The transzygomatic approach has been utilised to improve access to the skull base, infratemporal fossa and orbit for a number of years. It provides a low anterolateral approach to the skull base, along the floor of the middle fossa. It allows both a transsylvian and subtemporal approach with a reduction in brain retraction and better exposure of adjacent neurovasculature structures. A long term review of 53 patients is presented highlighting outcome at two years post surgery and morbidity of the approach. It is concluded that the technique is versatile and can be used to improve exposure of a variety of anatomical locations. There is minimal long term morbidity attributable to the surgery of access and the majority of patients have had good outcomes.     

中间入路腹腔镜下直肠癌高位前切除术回顾分析

目的探讨中间入路在腹腔镜辅助下直肠癌高位前切除手术中的操作技巧、应用价值及并发症情况。方法对术中使用中间入路作为显露和操作的26例肿瘤下缘在肛门口以上超过10cm的直肠上段癌和乙状结肠下段癌的临床资料进行总结分析。结果手术均获得成功,平均手术时间为(110.3±43.8)min,术中平均出血量为(71.7±88.8)ml。发生术后并发症2例,发生率为7.8%,其中切口感染1例,肠梗阻1例。患者平均住院天数为(13.53±9.23)d,切除淋巴结(13±34)枚。经石蜡标本病理检查证实,除1例为绒毛管状腺瘤、1例为类癌、余24例均为腺癌。其中,按TNM分期,Ⅰ期8例,Ⅱ期11例,Ⅲ期7例。所有病例均获随访1～15个月,有1例局部复发但无远处转移,无肿瘤相关死亡病例。结论中间入路腹腔镜辅助下直肠癌高位前切除手术是安全有效的手术径路。但采用该手术径路是否能达到与传统手术相同的肿瘤根治性仍有待进一步验证。     

Invisible scar endoscopic thyroidectomy by the dorsal approach: experimental development of a new technique with human cadavers and preliminary clinical results

Background A unilateral gasless single-surgeon videoendoscopic thyroidectomy procedure using a dorsal cephalic approach from the scalp with the option for a bilateral approach was developed with human cadavers and a porcine model for access training. The final preclinical trials and the first three clinical cases are described in detail. Methods Preclinical evaluation and training for the procedure were conducted with fresh human cadavers. The procedure was defined precisely by a sequence of nodal points initiating surgical steps. A quality score was developed by issuing each important anatomic structure a specific organ value and a factor for positive identification, inability to identify a given anatomic structure, spare it (meaning omit causing a lesion) or injure the structure. The quality of each operation was expressed as a single number or quality score value, calculated by summing the points achieved for the individual anatomic structures. The results of the procedures were controlled by prospective video documentation and autopsy. After conclusion of the preclinical training, the operation was performed for patients. The reported patients are part of a feasibility study approved by the institutional review board of the University of Munich. Results Nodal points were helpful in preparation for the operation by mental training. During the procedure, they helped to guide the preparation in the neck, where the working space must first be created on the way to the target organ. The surgical quality score improved over the first three cases and reached the maximum score, which was reproducible every time after that. It showed that the dorsal approach from the scalp to the thyroid gland is easily achievable without complications. The technical challenge is exposure of the recurrent laryngeal nerve (RLN) and the parathyroid glands. There was no difference between the results achieved by the resident and the senior surgeon. Preclinical training was good preparation for hemithyroidectomy in patients. All cases could be managed without postoperative hemorrhage or impairment of the parathyroid or the RLN. Conclusions Videoendoscopic thyroidectomy by the dorsal approach is feasible in both human cadavers and patients. It leaves no visible scars. Nodal points are helpful for executing a new operation. The surgical quality score is a complex and objective measure of ability to deal with the procedure. Further clinical studies are required for evaluation of this new procedure.     

经胸壁入路腔镜甲状腺切除术70例临床分析

目的:探讨经胸壁入路腔镜甲状腺切除术的优缺点。方法:2007年2月至2009年12月采用经胸壁三孔入路法行腔镜甲状腺切除术70例。其中甲状腺腺瘤18例,结节性甲状腺肿50例,甲状腺癌2例。结果:69例顺利完成腔镜手术,1例因术中出血中转开放。手术时间62～110min,平均80min,甲状腺肿瘤直径1.5～7.5cm,平均4.1cm。行甲状腺肿瘤切除术10例,单侧甲状腺次全切除术24例,单侧甲状腺腺叶切除术12例,双侧甲状腺部分切除术22例,甲状腺癌根治术2例。术后2～3d拔除引流管,术后住院2～5d,平均4d。2例术后声音嘶哑,均于6个月内恢复,3例术后一过性低钙,自行恢复,2例术后局部积液,经2～3次穿刺抽液后好转。术后随访2～35个月,未发现复发病例。结论:腔镜甲状腺手术安全可行,美容效果佳,其中经胸壁三孔入路法操作简便,是较理想的术式。