Smith Sarah L, Komisar Arnold
Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, and the Department of Otolaryngology, Lenox Hill Hospital, New York, NY, USA.
Laryngoscope. 2007 Jul;117(7):1163-7. doi: 10.1097/MLG.0b013e31806009fe.
Surgical techniques for parotid gland neoplasm removal have been shaped over the years by the importance of the gland's relationship with the facial nerve, histologic behavior of parotid tumors, and recurrence rates from specific techniques. Parotidectomy with facial nerve dissection has become the procedure of choice in removal of parotid gland neoplasms because of the resulting low recurrence rate. However, these more comprehensive dissections can cause significant postoperative complications, some cosmetically devastating. We propose that a more limited dissection yields a similar low recurrence rate but with less risk of complications.
Retrospective case series.
A retrospective review of the clinical outcomes and pathology of 27 patients who underwent extracapsular dissection for parotid gland neoplasms.
All tumors were located in the superficial lobe of the parotid gland and size of the masses ranged from 4.0 to 1.0 cm (mean 2.4 cm) in diameter. Pathology of the parotid tumors consisted of 11 pleomorphic adenomas, six Warthin's tumors, six benign epithelial cysts, one sarcoid lesion, two lymphoid hyperplasia, and one Kaposi's sarcoma. There were no cases of capsular rupture. There was no temporary or permanent facial paralysis and no incidence of Frey's syndrome. One patient developed a sialocele, which was aspirated and resolved after 3 months. There were no recurrences with follow-up times between 5 months and 6 years (mean 41 mo).
We advocate extracapsular dissection for benign parotid neoplasms because of the acceptable recurrence rates with limited complications as compared to superficial parotidectomy.
多年来，腮腺肿瘤切除的手术技术因腮腺与面神经的关系、腮腺肿瘤的组织学行为以及特定技术的复发率等因素而不断发展。由于面神经解剖的腮腺切除术复发率低，已成为腮腺肿瘤切除的首选术式。然而，这些更全面的解剖可能会导致严重的术后并发症，有些会造成毁容性后果。我们认为，更有限的解剖可产生相似的低复发率，但并发症风险更低。
回顾性病例系列研究。
对27例行腮腺肿瘤囊外解剖术患者的临床结果和病理进行回顾性分析。
所有肿瘤均位于腮腺浅叶，肿块直径4.0至1.0厘米（平均2.4厘米）。腮腺肿瘤病理包括11例多形性腺瘤、6例沃辛瘤、6例良性上皮囊肿、1例结节病、2例淋巴增生和1例卡波西肉瘤。无包膜破裂病例。无暂时性或永久性面瘫，无味觉出汗综合征发生。1例患者出现涎瘘，经抽吸后3个月消退。随访时间5个月至6年（平均41个月），无复发。
与浅叶腮腺切除术相比，我们主张对良性腮腺肿瘤行囊外解剖术，因为其复发率可接受且并发症有限。
