Park Sung Joon, Han Sungjun, Lee Hyo-Jung, Ahn Soon-Hyun, Jeong Woo-Jin
Clinical Assistant Professor, Department of Otorhinolaryngology - Head and Neck Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Clinical Fellow, Department of Otorhinolaryngology - Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.
J Oral Maxillofac Surg. 2018 Sep;76(9):2004-2010. doi: 10.1016/j.joms.2018.03.033. Epub 2018 Mar 28.
This study evaluated salivary function after extracapsular dissection (ECD) compared with partial superficial parotidectomy (PSP) and classic superficial parotidectomy (CSP) of benign parotid gland tumors. The authors hypothesized that ECD would be superior to PSP and CSP in preserving postoperative salivary function.
Retrospective analyses were performed for 43 consecutive patients who underwent parotidectomies of benign parotid tumors performed by a single experienced surgeon. Clinical data and pre- and postoperative whole salivary flow rates were compared among the operative procedures. Pearson χ and Fisher exact tests were used to compare categorical variables. Kruskal-Wallis, Mann-Whitney U, and Wilcoxon signed rank tests were used to compare means. A P value less than .05 was considered significant throughout the study.
Tumor sizes did not differ among groups. Operative times, amounts of drainage, and hospital days for ECD were markedly decreased compared with CSP and tended to be decreased compared with PSP. Resection margins were exposed in 0, 12.5, and 6.7% of patients who underwent ECD, PSP, and CSP, respectively. Postoperative complications occurred less often (but not meaningfully) after ECD. Postoperative basal salivary flow rates in the ECD, PSP, and CSP groups were 0.39, 0.32, and 0.14 mL/minute, respectively (P = .05). Stimulated salivary flow rates remained stable for the ECD and PSP groups but decreased in the CSP group.
ECD is a safe and time-efficient surgical approach, offering early recovery from parotid tumors and better preservation of salivary function. ECD should be considered a surgical approach for parotid tumors, especially those in the parotid tail region, such as Warthin tumors.
本研究评估了良性腮腺肿瘤行囊外剥离术（ECD）与部分浅叶腮腺切除术（PSP）及经典浅叶腮腺切除术（CSP）后的唾液功能。作者假设ECD在保留术后唾液功能方面优于PSP和CSP。
对由一位经验丰富的外科医生实施腮腺良性肿瘤切除术的43例连续患者进行回顾性分析。比较各手术方式的临床资料以及术前和术后的全唾液流速。采用Pearson χ检验和Fisher精确检验比较分类变量。采用Kruskal-Wallis检验、Mann-Whitney U检验和Wilcoxon符号秩检验比较均值。在整个研究中，P值小于0.05被认为具有统计学意义。
各组肿瘤大小无差异。与CSP相比，ECD的手术时间、引流量和住院天数明显减少，与PSP相比有减少趋势。接受ECD、PSP和CSP的患者中，分别有0、12.5%和6.7%的患者切缘暴露。ECD术后并发症发生率较低（但无显著意义）。ECD组、PSP组和CSP组术后基础唾液流速分别为0.39、0.32和0.14 mL/分钟（P = 0.05）。ECD组和PSP组刺激唾液流速保持稳定，而CSP组则下降。
ECD是一种安全且高效的手术方法，能使腮腺肿瘤患者早期康复，并更好地保留唾液功能。ECD应被视为腮腺肿瘤，尤其是腮腺尾部区域肿瘤（如沃辛瘤）的一种手术方法。
