Deans G T, Briggs K, Spence R A
Department of Surgery, Belfast City Hospital.
Ann R Coll Surg Engl. 1995 May;77(3):188-92.
The management of patients undergoing 50 surgical procedures to the parotid gland was reviewed. The overall accuracy of fine needle aspiration cytology was 87%, false-positive and false-negative rates for malignant disease both being 4%. The sensitivity, specificity and accuracy of fine needle cytology for malignant parotid tumours was 66%, 95%, and 91%, respectively, that of benign tumours (pleomorphic adenoma or Warthin's tumour) being 88%, 83% and 87%, respectively. Sensitivity, specificity and accuracy for the remaining (principally inflammatory) parotid diseases was 100%, 95% and 96%, respectively. The predictive value of a positive test for malignant tumours, benign tumours and inflammatory conditions was 66%, 94% and 75%, respectively. The negative predictive value for these conditions was 95%, 71% and 100%, respectively. Facial nerve weakness after parotidectomy occurred in three patients (8.8%), being permanent in two cases (both malignant). Although Frey's syndrome was not recorded in any of the notes, careful follow-up revealed two cases (6%). To date there have been no local recurrences after excision of either benign or primary malignant parotid masses. One patient with squamous cell carcinoma metastatic to the parotid gland died, despite block dissection of the neck and radiotherapy. This small series with a limited follow-up suggests that diseases of the parotid gland can be managed by general surgeons with an interest in this field. Although fine needle aspiration and ultrasonic scan may be helpful, the decision to operate should be made on clinical grounds.
对50例接受腮腺手术患者的治疗情况进行了回顾。细针穿刺细胞学检查的总体准确率为87%，恶性疾病的假阳性率和假阴性率均为4%。腮腺恶性肿瘤细针穿刺细胞学检查的敏感性、特异性和准确率分别为66%、95%和91%，良性肿瘤（多形性腺瘤或沃辛瘤）的相应数值分别为88%、83%和87%。其余主要为炎性腮腺疾病的敏感性、特异性和准确率分别为100%、95%和96%。恶性肿瘤、良性肿瘤和炎性疾病检测阳性的预测值分别为66%、94%和75%。这些疾病检测阴性的预测值分别为95%、71%和100%。腮腺切除术后有3例患者（8.8%）出现面神经麻痹，其中2例（均为恶性肿瘤）为永久性麻痹。虽然在所有记录中均未记载有弗雷综合征，但仔细随访发现2例（6%）。迄今为止，腮腺良性或原发性恶性肿块切除术后均未出现局部复发。1例腮腺转移鳞状细胞癌患者尽管接受了颈部淋巴结清扫术和放疗，仍死亡。这个随访有限的小样本系列表明，对该领域感兴趣的普通外科医生可以处理腮腺疾病。虽然细针穿刺和超声扫描可能会有所帮助，但手术决策应以临床情况为依据。
