目的:多形性腺瘤(混合瘤)是最常见的腮腺肿瘤,也是最常见的涎腺肿瘤类型之一,通常具有良性行为和相对缓慢的生长。腺瘤可能来自浅表,深的或来自浅表和深腮腺的裂片。
方法:本综述的目的是回顾性分析在耳鼻咽喉科(罗马的“AziendaPoliclinicoUmbertoI”的感官部门)进行的腮腺多形性腺瘤患者的手术治疗,从2010年到2020年,重点关注复发百分比和与手术相关的并发症,以建议复发性多形性腺瘤患者的最佳诊断和治疗算法。使用X2检验对在不同手术入路的情况下观察到的并发症进行分析。
结果:手术方法的选择(浅表腮腺切除术-SP,全腮腺切除术-TP,囊外解剖-ECD)取决于几个要素,例如腺瘤的位置和大小,现有技术设施的可用性和外科医生的专业经验。37.6%的人出现一过性面神经麻痹,2.7%报告永久性面神经麻痹,1.6%出现唾液瘘,1.6%为术后出血,2.3%为Frey综合征。
结论:这种良性病变需要手术治疗,即使在无症状的情况下,防止进行性生长并降低恶性转化的风险。手术切除的目标是获得完整的切除,以最大程度地减少肿瘤复发的风险并避免面神经残疾。因此,对病变进行准确的术前研究和选择最合适的手术治疗对于降低复发率至关重要。
OBJECTIVE: Pleomorphic adenoma (mixed tumor) is the most common neoplasm of the parotid gland and one of the most frequent types of salivary gland tumor, generally with benign behavior and relatively slow growing. The adenomas could arise from the superficial, deep or from both superficial and deep parotid\'s lobes.
METHODS: The aim of this review is to retrospectively analyze the surgical management of patients with pleomorphic adenoma of the parotid gland performed at the Department of Otorhinolaryngology (Department of Sense Organs of \"Azienda Policlinico Umberto I\" in Rome), from 2010 to 2020, with a focus on the percentage of recurrence and on the complication related to surgery to suggest an optimal diagnostic and therapeutic algorithm for patients with recurrent pleomorphic adenoma. The analysis of the complications observed in case of different surgical approaches was performed using the X2 test.
RESULTS: The choice of a surgical approach (superficial
parotidectomy-SP, total
parotidectomy-TP, extracapsular dissection-ECD) depends on several elements, such as the location and the size of the adenoma, the availability of existing technical facilities and the professional experience of the surgeon. A transient facial palsy was present in 37.6%, 2.7% reported a permanent facial nerve palsy, 1.6% developed a salivary fistula, 1.6% a post-operative bleeding and 2.3% showed Frey Syndrome.
CONCLUSIONS: The surgical management of this benign lesion is required, even in asymptomatic cases, to prevent the progressive growing and to reduce the risk of malignant transformation. The goal of surgical excision is to obtain the complete resection to minimize the risk of tumor recurrence and avoiding facial nerve disability. Therefore, an accurate preoperative
study of the lesion and the choice of the most appropriate surgical treatment are essential to minimize the rate of recurrence.