Chen Chien-Tzung, Huang Faye, Lin Yu-Te, Chen Yu-Ray, Lin Chih-Hung, Feng Guan-Ming
Department of Plastic and Reconstruction Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taipei, Taiwan, ROC.
Chang Gung Med J. 2004 Oct;27(10):718-25.
Advancements in endoscopic surgery, due in part to patient demands and in part to provision of superior medical care by surgeons, have significantly contributed to improvements in patients' quality of life. An endoscopic operation is minimally invasive, associated with faster recovery, and produces less postoperative morbidity. It is a well-accepted procedure in the field of plastic surgery. By applying the principle of endoscopic surgery used in facelift operations, we performed tumor excision in the forehead region.
Two 1.5-cm slit incisions were made in the anterior hairline. One incision was to allow access for the 4.0-mm, 30 degrees endoscope, and the other was for surgical instrumentation. These incisions, determined by the plane of dissection, were more superficial and below the subgaleal layer for soft tissue tumors and deeper into the subperiosteal layer for bone tumors. With good illumination and magnified monitor viewing, the tumors could clearly be visualized and were completely excised.
Seven patients with either dermoid cysts (3), osteomas (2), or lipomas (2) underwent endoscopically assisted procedures. In all cases, tumors were successfully excised with no acute or chronic complications. The average postoperative follow-up period was 7 months. No incidence of tumor recurrence was reported. All patients were satisfied with the resultant forehead contour and surgical scars.
The main advantage of this procedure is the fact that it is minimally invasive, thus reducing the incidence of injury to the neurovascular structures of the forehead as well as minimization of scar visibility. In conclusion, an endoscope-assisted approach is a good alternative method for managing benign soft-tissue and bone tumors in the forehead and brow region.
内镜手术的进展,部分归因于患者需求,部分归因于外科医生提供的优质医疗服务,这对改善患者生活质量有显著贡献。内镜手术是微创手术,恢复更快,术后发病率更低。它在整形手术领域是一种被广泛接受的手术方法。通过应用用于面部提升手术的内镜手术原理,我们在前额区域进行了肿瘤切除。
在前发际线处做两个1.5厘米的切口。一个切口用于插入4.0毫米、30度的内镜,另一个用于手术器械操作。这些切口根据解剖平面确定,对于软组织肿瘤,切口更浅,在帽状腱膜下层以下;对于骨肿瘤,则更深,进入骨膜下层。在良好的照明和放大的监视器观察下,肿瘤可以清晰地看到并被完全切除。
7例患有皮样囊肿(3例)、骨瘤(2例)或脂肪瘤(2例)的患者接受了内镜辅助手术。在所有病例中,肿瘤均成功切除,无急性或慢性并发症。术后平均随访期为7个月。未报告肿瘤复发情况。所有患者对前额轮廓和手术疤痕的结果都很满意。
该手术的主要优点是微创,从而减少了前额神经血管结构的损伤发生率,并使疤痕可见度降至最低。总之,内镜辅助方法是处理前额和眉部区域良性软组织和骨肿瘤的一种很好的替代方法。