【摘要】 目的 :探讨腮腺区神经鞘瘤的临床特点,并对其诊断、治疗及预后进行分析。方法 :收集2000年6月—2013年12月上海交通大学附属第九人民医院口腔颌面-头颈肿瘤科收治的52例腮腺区神经鞘瘤病例,分析患者临床特点、影像学检查、诊断、治疗及预后,采用SPSS13.0软件包进行Fisher精确检验。结果:9例术前有面瘫、不适等神经症状,占17.31%。术前确诊率为21.15%,52例患者均行手术治疗并经病理学检查确诊。术后随访42~206个月,未发现肿瘤复发及恶变。28例患者术后出现不同程度面神经损伤症状,占53.85%;10例患者损伤症状消失,8例患者不同程度改善,占64.29%。当肿瘤与面神经无明显关联时,手术治疗有效率为100%;当肿瘤位于面神经上时,切除术总有效率为22.22%,囊内摘除术总有效率为85.71%,切除且同期重建总有效率为85.71%,差异具有统计学意义。结论:腮腺区神经鞘瘤的术前确诊较难,确诊依赖病理诊断。该肿瘤需行手术治疗,术中应注意保护面神经,首选囊内摘除术;但当面神经离断及切除时,应尽可能同期行神经重建术,以期恢复患者面神经功能。更多还原

【Abstract】 PURPOSE: To investigate the clinical features, diagnosis, and treatment, as well as prognosis of neurinoma in parotid region, in order to provide references for clinical treatment. METHODS: Fifty-two cases of neurinoma in parotid region treated between June 2000 to December 2013 were retrospectively investigated, including their clinical characteristics,imaging examination, diagnosis, therapies and prognosis. SPSS13.0 software package was used for Fisher’s exact test.RESULTS: Nine cases(17.31%) in all had facial paralysis, discomfort and other neural symptoms before operation. Eleven cases(21.15%) was preoperatively diagnosed. All patients were treated with surgery, pathologically diagnosed and followed up for 42 months to 206 months. No recurrence and malignant transformation were found. Twenty-eight cases(53.85%) had symptoms of facial nerve injury postoperatively, but 18 cases(64.29%) were improved functionally. When there was no obvious correlation between the tumor and facial nerve, no facial nerve paralysis was found. When the tumor was located on the facial nerve, the rate of preserving facial nerve function was 22.22%, the rate of intracapsular enucleation of the neurinoma was 85.71%, and the effective rate of excision followed by facial nerve reconstruction was 85.71%.CONCLUSIONS: The diagnosis of neurinoma in parotid region is difficult and needed to be confirmed by postoperative pathology. The preservation of facial nerve function should be the utmost procedure during operation while intracapsular enucleation is the first choice. However, in order to restore the function of facial nerve, nerve reconstruction should be performed as soon as possible.更多还原