Chen Xiaohong, Xu Hongbo, Yang Zheng, Zhou Bing, Fang Jugao, Yu Zhenkun, Huang Zhigang
Department of Otolaryngology Head and Neck Surgery, Beijing Tong Ren Hospital, Capital Medical University, Ministry of Education, Beijing, 100730, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2012 Jun;26(11):513-6.
To investigate the feasibility of endoscope assisted resection of submandibular gland through a dermatoglyph incision.
We choose 5 patients diagnosed as benign diseases of submandibular gland from 2005 to 2010 in Beijing Tongren Hospital. Each patient was given a careful design of dermatoglyph incision preoperatively and an endoscope assisted surgery on the submandibular gland. The details of surgery procedure were described as follow. The inferior edge of the capsule of the submandibular gland was incised, and the traveling characteristics of facial artery, submandibuar gland branch of submental artery, branches of anterior facial vein were identified with endoscopic assistance. Branches of vascular and submandibular postganglionic fibers were treated with bipolar coagulation hemostasis. The submandibular duct was identified and isolated, teased downward from the floor of the mouth, and then ligated. The gland was lifted off the digastric tendon and removed. Suction drainage was used with a plastic tube and the incision was closed with mattress suture. The incision length, intraoperative bleeding, complication and operation duration were retrospectively, reviewed in the traditional group.
Of the endoscopic group, the incision lengths varied from 2.0-2.5 cm with an average of 2.3 cm. The operation durations varied from 41-87 min, with an average of 64 min. The total intraoperative bleeding was about 5 to 10 ml. No facial paralysis nor infection occurred both intra-and post-operatively. No relapse was detected in the long-term follow-up (4 months to 5 years). Compared with the traditional group, the incision length and bleeding decreased dramatically while the operational duration increased.
Endoscope assisted resection of submandibular gland through dermatoglyph incision will minimize the damage to surrounding tissue and obtain good cosmetic results.
探讨经皮纹切口在内镜辅助下切除下颌下腺的可行性。
选取2005年至2010年在北京同仁医院确诊为下颌下腺良性疾病的5例患者。术前为每位患者精心设计皮纹切口，并在内镜辅助下行下颌下腺手术。手术步骤细节如下。切开下颌下腺包膜下缘，在内镜辅助下辨认面动脉、颏下动脉下颌下腺分支、面前静脉分支的走行特点。血管分支和下颌下节后纤维用双极电凝止血。辨认并分离下颌下腺导管，从口腔底部向下游离，然后结扎。将腺体从二腹肌肌腱上提起并切除。用塑料管进行负压引流，切口用褥式缝合关闭。回顾性分析传统组的切口长度、术中出血、并发症及手术时间。
内镜组切口长度为2.0 - 2.5 cm，平均2.3 cm。手术时间为41 - 87分钟，平均64分钟。术中总出血量约5 - 10 ml。术中及术后均未发生面瘫及感染。长期随访（4个月至5年）未发现复发。与传统组相比，切口长度和出血量显著减少，而手术时间延长。
经皮纹切口在内镜辅助下切除下颌下腺可使周围组织损伤最小化，并获得良好的美容效果。
