Zanghì Antonio, Cavallaro Andrea, Marchi Martine, Marchi Marcello, La Via Luigi, Sanfilippo Filippo, Cappellani Alessandro, Di Majo Simone
Department of General Surgery and Medical-Surgical Specialties, Chief ChiSMaCoTA Research Center, AOU Policlinico "G. Rodolico - San Marco", Catania, Italy.
General Surgery III, Department of General Surgery and Medical-Surgical Specialties, University of Catania, AOU Policlinico "G. Rodolico - San Marco", Catania, Italy.
Front Surg. 2025 Jan 15;11:1415485. doi: 10.3389/fsurg.2024.1415485. eCollection 2024.
Salivary gland tumors represent only 3%-6% of all head and neck neoplasms, and approximately 70% of these tumors are located in the parotid gland. Most of these tumors are found in the more abundant superficial portion of the parotid gland, lateral to the facial nerve (FN). For many years, the location of the facial nerve between the superficial and deep segments of the parotid gland hindered adequate tumor extirpation. Several surgical options are available for the treatment of benign tumors in the parotid gland, but there remains no universal agreement on what the optimal surgical treatment is. In the early twentieth century, tumor enucleation was the standard treatment for parotid tumors to preserve the facial nerve, but high recurrence rates were the main downside of this procedure. To improve the outcome, superficial parotidectomy (SP) was implemented, which involves excision of the entire lateral segment of the parotid gland, superficial to the facial nerve. However, this surgical procedure may lead to severe postoperative complications, including facial nerve paralysis, in a significant number of patients. In recent years, more gland-preserving techniques were developed to reduce complication rates and improve the safety of procedures and patients' satisfaction, without increasing the risk of recurrence.
This study compares our surgical experience with extracapsular dissection gland-sparing surgery (ECD) to traditional superficial parotidectomy in 56 patients who underwent surgery performed by the same surgical team.
The superiority of ECD procedures compared to SP procedures was shown as far as total complication rates are concerned. In this case, Fisher's exact test statistic value was 0.0043 (significant at < 0.05).
ECD should be applied in properly selected cases and further prospective studies are needed to clarify the optimal indications.
唾液腺肿瘤仅占所有头颈部肿瘤的3%-6%，其中约70%的肿瘤位于腮腺。这些肿瘤大多位于腮腺较丰富的浅叶，面神经（FN）外侧。多年来，面神经位于腮腺浅叶和深叶之间的位置阻碍了肿瘤的充分切除。腮腺良性肿瘤的治疗有几种手术选择，但对于最佳手术治疗方法尚无普遍共识。在20世纪初，肿瘤剜除术是保留面神经的腮腺肿瘤标准治疗方法，但该手术的主要缺点是复发率高。为了改善治疗效果，实施了腮腺浅叶切除术（SP），该手术包括切除腮腺浅叶的整个外侧部分，即面神经浅面。然而，这种手术可能会导致大量患者出现严重的术后并发症，包括面神经麻痹。近年来，人们开发了更多保留腺体的技术，以降低并发症发生率，提高手术安全性和患者满意度，同时不增加复发风险。
本研究比较了同一手术团队对56例患者进行的囊外解剖保留腺体手术（ECD）与传统腮腺浅叶切除术的手术经验。
就总并发症发生率而言，ECD手术优于SP手术。在这种情况下，费舍尔精确检验统计值为0.0043（在<0.05时具有显著性）。
ECD应应用于适当选择的病例，需要进一步的前瞻性研究来明确最佳适应症。
