CAJ | 학술논문

目的与传统经颈入路比较,评价内镜辅助耳后发际入路颌下腺切除术的可行性及其利弊.方法 2009年1月至2010年1月,前瞻性对照研究28例颌下腺良性病变患者分别行两种术式的治疗结果.其中13例接受内镜辅助耳后发际入路手术,15例接受传统经颈入路手术.术前所有病例均行CT或MRI检查评估病损大小、位置、毗邻,并行细针穿刺活检明确病理.秩和检验比较两组患者的切口长度、手术时间、术中出血量、术后并发症及切口美容效果.结果 28例患者颌下腺均顺利完整切除.内镜组切口长度、手术时间与传统组比较,差异有统计学意义(Z值分别为-4.516和-3.263,P值均＜0.01);术后3个月,内镜组切口美容效果好于传统组,差异有统计学意义(Z=-4.472,P＜0.01).术后内镜组2例患者(15.4%)出现暂时性耳垂麻木、1例(7.7%)出现暂时性面神经下颌缘支麻痹,均在术后1个月缓解.所有病例随访10～24个月,中位随访18个月,未见复发.结论对于颌下腺良性疾病,内镜辅助耳后发际入路颌下腺切除术安全、可行.与传统经颈入路比较,切口隐蔽,美容效果确切.
목적 여전통경경입로비교,평개내경보조이후발제입로합하선절제술적가행성급기리폐.방법 2009년1월지2010년1월,전첨성대조연구28례합하선량성병변환자분별행량충술식적치료결과.기중13례접수내경보조이후발제입로수술,15례접수전통경경입로수술.술전소유병례균행CT혹MRI검사평고병손대소、위치、비린,병행세침천자활검명학병리.질화검험비교량조환자적절구장도、수술시간、술중출혈량、술후병발증급절구미용효과.결과 28례환자합하선균순리완정절제.내경조절구장도、수술시간여전통조비교,차이유통계학의의(Z치분별위-4.516화-3.263,P치균＜0.01);술후3개월,내경조절구미용효과호우전통조,차이유통계학의의(Z=-4.472,P＜0.01).술후내경조2례환자(15.4%)출현잠시성이수마목、1례(7.7%)출현잠시성면신경하합연지마비,균재술후1개월완해.소유병례수방10～24개월,중위수방18개월,미견복발.결론 대우합하선량성질병,내경보조이후발제입로합하선절제술안전、가행.여전통경경입로비교,절구은폐,미용효과학절.
Objective To assess the feasibility,the risks and the advantages of endoscope-assisted submandibular gland resection using a retroauricular hairline incision ( RAHI) by comparing it with the conventional submandibular gland resection.Methods Twenty eight patients with benign lesions of the submandibular gland were included in the prospective clinically controlled study.Thirteen patients had endoscope-assisted resection using the RAHI approach and 15 cases had conventional transcervical approach resection.The size,location and adjacency of all lesions were evaluated by CT or MRI before surgery.The pathologic diagnoses of all cases were identified as benign diseases using fine needle aspiration biopsy.The two groups were compared for incision length,operation time,bleeding,incision cosmetic result,and complications.Results All 28 operations were successfully performed.Incision length in the endoscopic group was significantly longer than that in the trancervical group (Z =-4.516,P＜0.01),and the surgical time was longer in the endoscopic group( Z =-3.263 ,P ＜0.01) .After three months the mean subjective satisfaction score for the incision scar in the endoscopic group was significantly higher than that in the trancervical group(Z=-4.472,P＜0.01).In the endoscopic group,2 cases (15.4%) with temporary numbness of the earlobe and 1 case (7.7% ) with a temporary marginal mandibular nerve paralysis were found postoperatively.However,they recovered within 1 month.All 28 patients were disease free with a follow-up of 10 to 24 months (median of 18 months).Conclusions Endoscope-assisted submandibular gland resection via RAHI is feasible and safe for the treatment of benign submandibular gland lesions.In comparison with the transcervical approach,this method can provide better cosmetic results without significant complications.