Unno T
Dept. of Otolaryngology, Asahikawa Medical School.
Gan To Kagaku Ryoho. 1988 Apr;15(4 Pt 2-2):1164-70.
Surgical treatment of malignant parotid tumors was described from the viewpoints of radical cure and postoperative function. The function of the parotid gland is originally the secretion of saliva, but this is generally compensated for by the remaining major and minor salivary glands. Therefore, postoperative dysfunction involves possible facial palsy, deformity of the face and Frey's syndrome due to extirpated gland parenchyma and surrounding tissues. For these reasons, preservation of the facial nerve is required and resection of the gland should be as limited as the condition demands. If these procedures are impossible, plastic surgery such as nerve grafting and skin or musculocutaneous flaps is utilized. Postoperative irradiation is not applied except for unusual cases. Because malignant tumors of the parotid gland are histologically and biologically very different, preoperative examination is important for select the subsequent treatment. Superficial parotidectomy for a tumor in the superficial lobe and total parotidectomy for one in the deep lobe is the general concept adopted today. However, uniform application of this concept does not seem to simultaneously fulfil both purposes. In order to satisfy radical and functional results, delicately applied surgical techniques applied to individual cases are recommended according to the findings of appropriate preoperative and intraoperative examinations.
从根治和术后功能的角度描述了腮腺恶性肿瘤的外科治疗。腮腺的功能原本是分泌唾液，但这通常由剩余的大、小唾液腺来代偿。因此，术后功能障碍包括因切除腺实质和周围组织而可能出现的面神经麻痹、面部畸形和味觉出汗综合征。基于这些原因，需要保留面神经，并且腺体切除应根据病情需要尽可能有限。如果这些操作无法进行，则采用诸如神经移植和皮肤或肌皮瓣等整形手术。除特殊情况外，术后不进行放疗。由于腮腺恶性肿瘤在组织学和生物学上差异很大，术前检查对于选择后续治疗很重要。对于浅叶肿瘤行浅叶腮腺切除术，对于深叶肿瘤行全腮腺切除术是目前普遍采用的概念。然而，统一应用这一概念似乎无法同时实现两个目的。为了达到根治和功能效果，建议根据适当的术前和术中检查结果，针对个别病例精心应用手术技术。
