国际口腔医学杂志

国际口腔医学杂志 ›› 2021, Vol. 48 ›› Issue (2): 230-237.doi: 10.7518/gjkq.2021034

• 综述 • 上一篇    下一篇

下颌下腺良性肿瘤功能性手术的研究进展

沈洁(),何地,刘雁鸣()   

  1. 浙江大学医学院附属第二医院口腔颌面外科 杭州 310009
  • 收稿日期:2020-08-14 修回日期:2020-12-12 出版日期:2021-03-01 发布日期:2021-03-17
  • 通讯作者: 刘雁鸣
  • 作者简介:沈洁,硕士,Email： 21818179@zju.edu.cn

Research progress on the functional surgery of benign submandibular gland tumors

Shen Jie(),He Di,Liu Yanming()   

  1. Dept. of Oral and Maxillofacial Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
  • Received:2020-08-14 Revised:2020-12-12 Online:2021-03-01 Published:2021-03-17
  • Contact: Yanming Liu

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摘要：

下颌下腺切除术是治疗下颌下腺良性肿瘤最常用的治疗方法,但术后皮肤瘢痕、潜在的面神经下颌缘支损伤和舌神经损伤,以及腺体摘除可能导致的口干等并发症将会不同程度地影响患者的生活质量。为此,下颌下腺功能性手术日益被采用和改进,以期提高术后生活质量。本文围绕下颌下腺手术的美观切口设计,内镜和机器人辅助手术技术的应用,以及下颌下腺区重要组织的功能保护等3个方面对下颌下腺良性肿瘤的功能性手术的进展进行综述,以期为临床治疗方案选择提供参考。

关键词: 下颌下腺良性肿瘤, 下颌下腺疾病, 功能性手术, 下颌下腺部分切除术, 机器人外科手术, 内镜

Abstract:

Submandibular gland resection is the most widely accepted treatment for benign submandibular gland tumors. However, postoperative complications such as external scar formation in a highly visible area, increasing incidence of damage to facial and lingual nerves, and xerostomia seriously affect patients' quality of life. As such, the functional surgery of the submandibular gland has been widely used. This review summarized the research progress on functional surgery as a treatment for benign submandibular gland tumors in terms of three aspects to provide a reference for the clinical treatment of benign submandibular gland neoplasms: 1) modified surgical approaches to improve cosmetic results and decrease complications, 2) endoscopic techniques and surgical robot systems in submandibular gland surgery, and 3) opera-ting techniques to preserve the function of important tissues in the submandibular gland region.

Key words: submandibular gland neoplasms, submandibular gland diseases, functional surgery, partial submandibular gland resection, robotic surgical procedures, endoscopes

中图分类号: 

  • R739.87

图1

下颌下腺手术切口设计示意图 蓝色：发际线-耳后切口;橙色：改良发际线切口;黄色：传统颈侧切口;绿色：改良下颌下区颈侧小切口;红色：颏下舌骨水平切口;灰色：锁骨上切口;粉色：锁骨下切口。"

表1

传统开放式手术方法、内镜辅助手术技术和机器人辅助手术技术优缺点对比"

优缺点 传统开放式手术 内镜辅助手术 机器人辅助手术
优点 1）术区暴露充分,便于控制术中出血;
2）至术区路程短;
3）便于扩大切口及手术范围;
4）仍为下颌下腺与周围组织粘连较为严重的炎性病损以及下颌下腺区恶性肿瘤的首选手术方法		 1）可制作远程隐蔽区切口,较为美观;
2）局部放大视野,减少组织损伤;
3）全内镜下手术可获得较大手术活动范围,便于较大肿瘤的切除		 1）可制作远程隐蔽区切口,较为美观;
2）机械臂机动性佳,减少了术者手颤动对手术的影响,操作更准确;
3）机械臂360°的运动范围,可达到刚性的内镜仪器难以进入的术区;
4）可实现三维放大视野,更清晰辨认组织结构,操作更安全;
5）术中出血量较少
缺点 1）术后颈部瘢痕较明显,美观性不足;
2）术中面神经下颌缘支、舌神经、舌下神经易损伤		 1）不可呈现三维手术视野,呈平面暴露视野;
2）器械笔直,易造成手术器械碰撞;
3）依赖助手控制手术视野;
4）不适用于下颌下腺与周围组织严重粘连的病损		 1）手术费用较高;
2）技术敏感性;
3）手术时间较长;
4）缺乏触觉反馈;
5）不适用于与周围组织严重粘连的下颌下区病损

图2

面神经下颌缘支非识别法的手术模式图 黑色箭头示手术解剖方向。"

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