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1、面神经解剖在腮腺手术中临床意义[摘要]目的:探讨面神经解剖在腮腺肿瘤切除术中的意义。方法:回顾性分折199旷2005年我科施行腮腺肿瘤切除术101例。面神经解剖86例(85.1%,86/101)o面神经总干解剖15例,面神经下颌缘支解剖71例。3例恶性肿瘤和12例小腺瘤未行面神经解剖。腮腺局部切除12例,腮腺浅叶切除74例,腮腺全切除15例。结果:全组术后随访9〜33个月,无肿瘤复发病例。4例术后腮腺痿,7-10d痊愈。1例永久性面瘫。无术后出血、感染等并发症。结论:面神经解剖有助于完整切除腮腺肿瘤和防止面神经医原性损伤。美蓝染色可在术中有效识别
2、面神经。[关键词]面神经;解剖;腮腺;外科[中图分类号1R739[文献标识码]C[文章编号]1673-7210(2008)08(c)-219-02ClinicalsignificationoffacialnerveanatomyinparotidoperationZHANGXue-huil,XIAOPing2,HUANGJian-nanl,FUXiang-junl(1.DepartmentofOtorhinolaryngology-HeadandNeckSurgery,SecondPeople,sHospitalofGuangdong,Guang
3、zhou510310,China;2.Medicalcollege,UniversityofsouthChina,Henyang421001,China)[Abstract]Objective:Tostudythesignificationoffacialnerveanatomyduringparotidoperation.Methods:Thispaperwastosummarizeandanalyzeretrospectivelytheclinicalexperienceof101caseswiththeparotid-tumorwhower
4、eperformedoperationfrom1998to2005.Ofthese101cases,facialnervewereanatomizedin86cases(85・1%,86/101),includingfacialnervecon-caudexanatomyin15cases,ramusmarginalmandibulaenervousfacialanatomyin71cases・Malignanttumorin3casesandlittleadenoidtumorin12casesweren^tfacialnerveanatomy
5、.Basedondemandofthetreatment,parotidlocalexcisionin12cases,parotidsuperficial-lobeexcisionin74casesandparotidtotalexcisionin15caseswereperformed.Results:Followed-upallofpatientsfor9〜33months,postoperatively,noonerecurrence・Fistulaofparotidglandoccurredin4casesand7〜10dayswereh
6、ealedthroughchangingdressingandpermanencefacialpalsyin1casesandnopost-operativecomplicationssuchasbloodingorinfectionwereobserved・Conclusion:Itisoneofeffectivemeasuresinparotidoperationswithfacialnerveanatomyforpreventingfacialnerveiatrogenicdamage・Methyleneblueishelpfultodis
7、criminatefacialnerve・[Keywords]Facialnerve;Anatomy;Parotidtumor;Surgery腮腺部分或全切除术是治疗腮腺肿瘤的主要方法,因腮腺肿瘤与面神经关系密切,而术中面神经损伤是常见并发症。无论病人和家属,还是医师,均对术中面神经是否受损,或受损后面神经功能是否能够恢复正常极为关注。因此,除非因恶性肿瘤侵犯面神经而需有意识地牺牲面神经,术中均应对面神经妥加保护,面神经处理是腮腺手术的关键技术。笔者统计101例腮腺手术,就相关问题报道如下:1资料与方法1.1一般资料本组病例101例,统计时间为1
8、998〜2005年。其中男67例,女34例。年龄17〜74岁。耳前肿块10例,耳后肿块27例,耳垂下肿块64例。无痛性肿块88例,局部触