Gao Li, Shao Yan, Xie Lei, Hu Ying, Li Hua, Ye Xue-Hong, Song Chun-Yi
Department of Head and Neck-plastic and Reconstructive Surgery, Sir Run Shaw Hospital, Medical College, Zhejiang University, Hangzhou 310016, China.
Zhonghua Zheng Xing Wai Ke Za Zhi. 2004 Jul;20(4):290-3.
To evaluate a technique of endoscope-assisted parotidectomy for benign tumor via a short hidden auricular incision.
Twenty-six volunteer patients were selected for the new approach, 16 with mixed tumor, 9 Warthin's tumor and 1 lymphoepithelial cyst. The tumor size was 1.6 approximately 3 cm (average 2.2 cm) and the incision ranged 3.5 approximately 5.5 cm(average 4.5cm) divided into two parts: 1) basic segment--started from anterio-superior crease of tragus, went downward along tragal margin and pre-earlobial fold,and stopped at earlobe root; 2) extended segment--went from earlobe root, curved down posterio-inferiorly. The length of the latter was generally not beyond 1 cm. The procedure began with raising the myo-cutaneous flap and dissecting the whole posterior portion of the gland. Thus, two working spaces needed for endoscopic manipulation could be artificially created with suitable retracting instruments. Endoscopic view was then established, and the surgeons operated continuously in the later steps. Modified techniques, such as the antegrade facial nerve dissection, retrograde great auricular nerve dissection and direct coagulate-cut method with ultrasonically activated scalpel, were employed to archive the goals of endoscopical nerve preservation and tissue resection.
All tumors were entirely removed. No postoperative paralysis occurred, excepting 1 case who suffered from an temporary paralysis for two months. The appearance was good due to overlapping the short scar onto the irregular line of auricular contour and hiding its lowest part in the earlobe shadow.
Parotidectomy for benign tumors could be safely done via a much-shortened incision, assisted by an endoscope. The postoperative stress of patients can be obviously reduced with the minimally invasive manipulation and the good appearance.
评估一种经耳前短隐匿切口的内镜辅助腮腺良性肿瘤切除术技术。
选取26例志愿患者采用新方法进行手术，其中16例为混合瘤，9例为沃辛瘤，1例为淋巴上皮囊肿。肿瘤大小约为1.6至3厘米（平均2.2厘米），切口长度为3.5至5.5厘米（平均4.5厘米），分为两部分：1）基础段——起自耳屏前上皱襞，沿耳屏边缘和耳前皱襞向下延伸，止于耳垂根部；2）延伸段——从耳垂根部开始，向后下弯曲。后者长度一般不超过1厘米。手术首先掀起肌皮瓣，解剖腺体的整个后部。这样，借助合适的牵开器械可人为制造出两个内镜操作所需的工作空间。然后建立内镜视野，外科医生在后续步骤中持续操作。采用了改良技术，如顺行面神经解剖、逆行耳大神经解剖以及使用超声刀直接凝固切割法，以实现内镜下神经保留和组织切除的目标。
所有肿瘤均被完整切除。除1例出现两个月的暂时性面瘫外，无术后面瘫发生。由于短瘢痕与耳廓轮廓的不规则线重叠，且其最低部分隐藏在耳垂阴影中，外观良好。
在内镜辅助下，经大幅缩短的切口可安全地进行腮腺良性肿瘤切除术。微创操作和良好外观可明显减轻患者的术后应激。
