- 期刊
The Advantages of Microsurgical Dissection Applied to Parotidectomy for Benign Lesions
以顯微手術剖析法協助切除良性腮腺腫瘤的優點
摘要
顔面神經功能的保護在腮腺腫廇切除手術時是一個十分重要的原則。顯微手術剖析法協助切除良性腮腺腫瘤已經應用於21個病人的手術上。其中一個病人是動靜脈畸形，其餘20個病人是多形性腺瘤。本研究結果顯示在淺層腮腺腫瘤切除手術中只有一個病人有輕度的顔面神經功能受損(6.25%)，而在全腮腺腫瘤切除手術中則有兩個病人有輕度的顔面神經功能受損(40%)。總括而言，有14.3%的病人有短暫的顔面神經功能受損現象，沒有發現有永久性的顔面神經功能受損。這些不對稱的情形在追蹤了三個月之後就消失了。在平均手術時間方面，淺層腮腺腫瘤切除手術須花3個小時，而全腮腺腫瘤切除手術則須花3.5個小時。 在顯微鏡下剖析以切除腮腺腫瘤有下列五點好處：(1)精確地識別及保護所有的顔面神經分枝 (2)保護供應神經的營養血管 (3)避免不注意的電燒傷害，尤其是復發性的腫瘤切除 (4) 最輕微的牽扯 (5)不須非常高明的技術或豐富的經驗也可以達到避免顔面神經功能受損的目的。在顯微鏡下剖析以切除腮腺腫瘤的缺點則是需花費較長的手術時間。我們在此推薦這種精細的手術方式以切除良性腮腺腫瘤，經由這種術式可以減少顔面神經暫時性麻痺的發生及隨之而來對病患心理層面的衝擊。特別是當腮腺瘤很大或是復發性的腮腺腫瘤。
關鍵字
無資料並列摘要
Preservation of facial nerve function is a fundamental principle of parotid gland surgery. Microsurgical dissection has been applied to the resection of benign parotid tumors in 21 cases. One of them was AVM and the other cases were pleomorphic adenoma. The results showed that only 1 (6.25%) had minimal facial weakness in the group of superficial parotidectomy and 2 (40%) in the group of parotidectomy. In this study, only 3 patients (14.3%) encountered temporary weakness of the facial nerve and no permanent paralysis or weakness noted. The asymmetry disappeared at 3 months of follow-up. The average operation time was 3 hours for superficial parotidectomy and 3.5 hours for total parotidectomy. Dissection under microscope for parotidectomy has the following advantages: (1) Meticulous identification and preservation of all nerve branches. (2) Preservation of blood supply to the nerve branches, even in total parotidectomy. (3) Avoidance of inadvertent cauterization to minor branches, especially in recurrent cases. (4) Minimal traction. (5) Achieving same good results with basic microsurgical technique and experience. Dissection under microscope has the disadvantages of longer operation time. We propose a meticulous method for parotidectomy of benign lesions, which can reduce the incidence of temporary facial paresis and resultant psychological impact, especially in large tumors or recurrent cases.