Bhattacharyya Neil, Richardson Marc E, Gugino Laverne D
Division of Otolarygology, Brigham and Women's Hospital and the Department of Otology and Larngology, Harvard Medical School, Boston, MA 02115, USA.
Otolaryngol Head Neck Surg. 2004 Oct;131(4):392-6. doi: 10.1016/j.otohns.2004.03.012.
This study was undertaken to determine whether the retrograde parotidectomy approach is more efficient than standard anterograde parotidectomy without compromise of surgical effectiveness.
A retrospective analysis of patients undergoing parotidectomy was conducted. Cases were divided into those undergoing retrograde facial nerve dissection and those undergoing standard anterograde facial nerve dissection. From the review of medical records, standard demographic information, surgical time, histopathology, estimated blood loss, and use of facial nerve monitoring were determined. Pathology was reviewed to determine the size of the overall resection specimen as well as the size of the lesion excised and margin status. Postoperative complications were also recorded. Statistical comparisons were conducted between these 2 approaches for these clinical variables such as surgical time, blood loss, tumor margin status and relative volume of tissue removed during parotidectomy.
45 patients undergoing parotidectomy met inclusion criteria. The average patient age was 50.8 years with a female preponderance (73%). There were 19 standard parotidectomies and 26 retrograde approaches. Compared to standard parotidectomy, retrograde parotidectomy consumed less operative time (3.2 versus 1.8 hours, respectively), decreased intraoperative blood loss (67.9 cc versus 40.3 cc, respectively), and resulted in less removal of normal parotid tissue (volume of normal parotid tissue removed in excess of tumor: 23.0 cc versus 6.0 cc, respectively). No significant difference in surgical margin status was noted between anterograde and retrograde parotidectomy (P = 0.452).
In appropriately selected cases, compared with standard anterograde parotidectomy, retrograde parotidectomy is more efficient and spares normal parotid tissue without compromising surgical margins. Facial nerve monitoring provides a useful adjunct for retrograde dissection.
本研究旨在确定逆行腮腺切除术是否比标准顺行腮腺切除术更有效，且不影响手术效果。
对接受腮腺切除术的患者进行回顾性分析。病例分为接受逆行面神经解剖的患者和接受标准顺行面神经解剖的患者。通过查阅病历，确定标准人口统计学信息、手术时间、组织病理学、估计失血量以及面神经监测的使用情况。对病理进行复查，以确定整个切除标本的大小以及切除病变的大小和切缘状态。还记录了术后并发症。对这两种手术方法在手术时间、失血量、肿瘤切缘状态以及腮腺切除术中切除的正常组织相对体积等临床变量方面进行了统计学比较。
45例接受腮腺切除术的患者符合纳入标准。患者平均年龄为50.8岁，女性占优势（73%）。有19例标准腮腺切除术和26例逆行手术。与标准腮腺切除术相比，逆行腮腺切除术的手术时间更短（分别为3.2小时和1.8小时），术中失血量减少（分别为67.9毫升和40.3毫升），并且正常腮腺组织切除量更少（切除的超过肿瘤体积的正常腮腺组织量：分别为23.0毫升和6.0毫升）。顺行和逆行腮腺切除术在手术切缘状态方面未发现显著差异（P = 0.452）。
在适当选择的病例中，与标准顺行腮腺切除术相比，逆行腮腺切除术更有效，能保留正常腮腺组织且不影响手术切缘。面神经监测为逆行解剖提供了有用的辅助手段。
