Clinical application of retroauricular hairline approach in submandibular gland resection assisted by endoscope
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摘要: 目的 探讨腔镜辅助下经耳后发际内入路在颌下腺切除术的临床效果。方法 选择2022年9月至2023年9月治疗的颌下腺良性肿瘤患者18例，在耳后发际内设计长约5 cm切口，先直视下翻瓣至胸锁乳突肌前缘附近，通过腔镜翻瓣建腔，在腔镜辅助下完成颌下腺切除术。术后经发际内放置负压引流，皮内连续缝合关闭创口。术后随访3~6个月，评价其临床效果。结果 所有患者均按计划经腔镜辅助下完成颌下腺切除术，术中无一例中转为颌下切口。手术时间65~97 min，平均75 min；术中出血10~20 mL，平均14 mL；术后无舌体麻木、创口感染、肿瘤复发等情况出现，但有10例患者术后出现耳廓麻木不适，经随访6~9个月逐渐恢复；2例患者术后发生口角歪斜，经随访后症状逐渐缓解；切口均Ⅰ期愈合，且部位隐蔽。结论 腔镜辅助经耳后发际内入路在颌下腺切除术的美容效果好、创伤小、并发症少，是颌下腺切除的一种手术入路选择。Abstract: Objective To investigate the clinical effect of retroauricular hairline approach in submandibular gland resection assisted by endoscope.Methods A total of 18 patients with submandibular gland benign tumors treated in our hospital from September 2022 to September 2023 were selected. A 5 cm incision was designed in the retroauricular hairline, and the flap was turned over directly to the anterior edge of sternocleidomastoid muscle, then the flap was turned over to build the cavity through endoscopic surgery, and submandibular gland resection was completed with the assistance of endoscope. After operation, a negative pressure drainage was placed into the hairline, and the wound was closed by continuous intracutaneous suture. The clinical effect was evaluated after 3-6 months follow-up.Results All patients underwent submandibular gland resection with endoscopic assistance as planned, and none of them converted to submaxillary incision during operation. The operation time was 65-97 min, with an average of 75 min. Intraoperative bleeding was 10-20 mL, with an average of 14 mL.No tongue numbness, wound infection, or tumor recurrence occurred after operation. However, there were 10 patients with ear numbness and discomfort of auricle after surgery, which gradually recovered after 6-9 months of follow-up. Two patients had crooked mouth after surgery, and the symptoms were gradually relieved after follow-up. All incisions healed in stage I and were concealed.Conclusion Endoscopic retroauricular hairline approach is a choice for submandibular gland resection with good cosmetic effect, less trauma and fewer complications.
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Key words:
- submandibular gland /
- endoscope /
- ultrasonic knife /
- minimally invasive incision
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[1] 徐典, 许立志, 吴中明, 等. 腔镜辅助下经口内入路颌下腺切除术临床效果研究[J]. 陕西医学杂志, 2021, 50(9): 1127-1130, 1169. doi: 10.3969/j.issn.1000-7377.2021.09.021
[2] Baek CH, Jeong HS. Endoscope-assisted submandibular sialadenectomy: a new minimally invasive approach to the submandibular gland[J]. Am J Otolaryngol, 2006, 27(5): 306-309. doi: 10.1016/j.amjoto.2005.11.018
[3] Chen XL, Li C, Zhou YD, et al. Resection of submandibular gland and tumor via transaxillary gasless endoscopy: a case report[J]. Chin J Otorhinolaryngol Head Neck Surg, 2022, 57(2): 212-214.
[4] 彭福森, 杜友红, 张欣, 等. 全腔镜下经锁骨下径路颌下腺腺叶切除[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(6): 471-473. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.1001-1781.2016.06.013
[5] Yang F, Alkebsi K, Chen S, et al. Gasless endoscopic submandibular gland excision through hairline approach[J]. J Craniofac Surg, 2023, 34(5): 1563-1569. doi: 10.1097/SCS.0000000000009363
[6] 井溢鑫, 丁一鸣, 周晶, 等. 无注气经颈侧腔镜胸锁乳突肌后下入路在甲状腺手术中的应用[J]. 临床耳鼻咽喉头颈外科杂志, 2023, 37(9): 691-694. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.2096-7993.2023.09.002
[7] 刘利, 陈志峰, 朱小朝, 等. 经腋窝入路与经胸乳入路腔镜单侧甲状腺叶切除治疗甲状腺良性肿瘤的疗效[J]. 局解手术学杂志, 2023, 32(9): 825-829. https://www.cnki.com.cn/Article/CJFDTOTAL-JJXZ202309014.htm
[8] 刘培根, 耿成义, 罗杰, 等. 机器人与腔镜手术治疗甲状腺癌对嗓音功能影响的回顾性病例对照研究[J]. 中国普外基础与临床杂志, 2023, 30(11): 1353-1358. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWL202311013.htm
[9] 吴昊, 王婷婷, 宁伟, 等. 无充气腋窝入路完全腔镜下甲状腺癌根治术的效果观察[J]. 临床医学, 2023, 43(10): 17-20. https://www.cnki.com.cn/Article/CJFDTOTAL-EBED202310005.htm
[10] Monfared A, Sáenz Y, Terris DJ. Endoscopic resection of the submandibular gland in a porcine model[J]. Laryngoscope, 2002, 112(6): 1089-1093. doi: 10.1097/00005537-200206000-00028
[11] Guyot L, Duroure F, Richard O, et al. Submandibular gland endoscopic resection: a cadaveric study[J]. Int J Oral Maxillofac Surg, 2005, 34(4): 407-410. doi: 10.1016/j.ijom.2004.11.001
[12] 谭孟婷, 杜友红. 经锁骨下径路全腔镜下颌下腺手术[J]. 世界最新医学信息文摘, 2015, 15(A4): 50-58. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA2015A4027.htm
[13] 何佳潞, 陈塑, 杨帆, 等. 耳后发际入路完全腔镜下颌下腺切除术的临床分析[J]. 肿瘤预防与治疗, 2023, 36(11): 962-969. doi: 10.3969/j.issn.1674-0904.2023.11.009
[14] 谭孟婷. 全腔镜下颌下腺切除术和传统颌下腺手术的对照研究[D]. 衡阳: 南华大学, 2016.
[15] Meningaud JP, Pitak-Arnnop P, Bertrand JC. Endoscope-assisted submandibular sialoadenectomy: a pilot study[J]. J Oral Maxillofac Surg, 2006, 64(9): 1366-1370. doi: 10.1016/j.joms.2006.05.032
[16] Kim JP, Park JJ, Woo SH. Endoscope-assisted hairline approach for resecting maxillofacial masses[J]. Int J Oral Maxillofac Surg, 2020, 49(3): 310-316. doi: 10.1016/j.ijom.2019.06.026
[17] Kathar MA, Jain P, Manikantan K, et al. Feasibility, Safety, Nodal yields and Learning curves in Retroauricular Robot/Endoscope Assisted Neck Dissection in the Management of Head and Neck Cancer[J]. Indian J Surg Oncol, 2021, 12(4): 808-815. doi: 10.1007/s13193-021-01444-z
[18] Chen S, Alkebsi K, Xuan M, et al. Single incision-plus approach for gasless endoscopic parotidectomy: a seven-step procedure[J]. Transl Cancer Res, 2022, 11(7): 2462-2472. doi: 10.21037/tcr-22-226
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