保留耳大神經在腮腺良性腫瘤中的臨床研究

關華　王斌　馮靚婧　劉志剛

[摘要]目的 討論腮腺良性腫瘤手術中保留耳大神經的臨床意義。 方法 將50例腮腺良性腫瘤患者隨機分為兩組，觀察組25例行區域性切除術、術中保留耳大神經，對照組25例行腮腺淺葉或全葉及腫物切除術，術中不保留耳大神經。比較兩組耳廓及周圍皮膚的感覺障礙程度。 結果 觀察組術后3個月耳廓區感覺損傷面積與對照組比較差異無統計學意義（P>0.05），而術后6個月和12個月損傷面積明顯小于對照組（P<0.05）。觀察組術后耳廓區感覺異常幾率明顯低于對照組，且觀察組內出現暫時性局部麻木的病例神經功能恢復的速度也明顯快于對照組（P<0.05）。 結論 保留耳大神經對腮腺腫瘤術后耳廓感覺功能恢復意義重大。

[關鍵詞]耳大神經；腮腺腫瘤手術；感覺障礙

[中圖分類號] R739.8 [文獻標識碼] B [文章編號] 2095-0616（2015）24-195-03

[Abstract]Objective To discuss the clinical significance of preserving the great auricular nerve in parotidectomy. Methods 50 patients with parotidectomy were randomly divided into two groups. Patients in observed group （25cases） were treated with local excision of benign tumor of the parotid gland， and the great auricular nerve were retained. Patients in control group （25cases） were treated with resection of superficial lobe of parotid gland or whole leaf and tumor， and the great auricular nerve were not retained. The sensory disturbance degree of auricle and its surrounding skin between the two groups were compared. Results There was no significantly difference in the injury area of auricle between the two groups at 3rd month after treatment （P>0.05）. The injury area of auricle in two groups at 6th month and 12th month after the treatment were significantly smaller than those before treatment（P<0.05）. The injury area of auricle in observed groups at 3nd month， 6th month and 12th month were significantly smaller than those in control groups（P<0.05）. The sensory abnormality rate of observed group were significantly lower than those of control groups （P<0.05）. The rate of nerve function recovery of observed group was also significantly faster than those of control group（P<0.05）. Conclusion It is important to preserve the great auricular nerve for the recovery of sensory function of the parotid gland after surgery.

[Key words] Great auricular nerve； Parotidectomy； Sensory disturbance

腮腺腫瘤是頭頸部常見腫瘤，治療方式以手術治療為主[1]。以往手術中強調的多是對面神經的保護及腫瘤切除的徹底性，對耳大神經的保留常常被外科醫生所忽視，結果導致耳大神經支配區的長期麻木[2]。隨著社會的進步，在保證手術切除徹底性的同時，術后局部感覺障礙越來越被患者及手術醫生所重視。我科2010年7月～2014年6月對50例腮腺良性腫瘤患者進行了保留耳大神經與不保留耳大神經隨機對照研究，現報道如下。

1 資料與方法

1.1 一般資料

選取我院2010年7月～2014年6月收治的50例腮腺良性腫瘤患者，均于術前經超聲、CT證實，且病理檢驗為單發良性腫瘤。男30例，女20例；年齡20～78歲，平均（48.8±16.2）歲。術后蘇木精-伊紅染色及免疫組織化學證實[3]：多形性腺瘤22例，Waithin瘤15例，基底細胞腺瘤11例，神經鞘瘤1例，囊腫1例。按入院先后順序將患者隨機分為兩組各25例，兩組患者一般資料比較差異無統計學意義（P>0.05），具有可比性。