关华　王斌　冯靓婧　刘志刚

[摘要]目的 讨论腮腺良性肿瘤手术中保留耳大神经的临床意义。 方法 将50例腮腺良性肿瘤患者随机分为两组，观察组25例行区域性切除术、术中保留耳大神经，对照组25例行腮腺浅叶或全叶及肿物切除术，术中不保留耳大神经。比较两组耳廓及周围皮肤的感觉障碍程度。 结果 观察组术后3个月耳廓区感觉损伤面积与对照组比较差异无统计学意义（P>0.05），而术后6个月和12个月损伤面积明显小于对照组（P<0.05）。观察组术后耳廓区感觉异常几率明显低于对照组，且观察组内出现暂时性局部麻木的病例神经功能恢复的速度也明显快于对照组（P<0.05）。 结论 保留耳大神经对腮腺肿瘤术后耳廓感觉功能恢复意义重大。

[关键词]耳大神经；腮腺肿瘤手术；感觉障碍

[中图分类号] R739.8 [文献标识码] B [文章编号] 2095-0616（2015）24-195-03

[Abstract]Objective To discuss the clinical significance of preserving the great auricular nerve in parotidectomy. Methods 50 patients with parotidectomy were randomly divided into two groups. Patients in observed group （25cases） were treated with local excision of benign tumor of the parotid gland， and the great auricular nerve were retained. Patients in control group （25cases） were treated with resection of superficial lobe of parotid gland or whole leaf and tumor， and the great auricular nerve were not retained. The sensory disturbance degree of auricle and its surrounding skin between the two groups were compared. Results There was no significantly difference in the injury area of auricle between the two groups at 3rd month after treatment （P>0.05）. The injury area of auricle in two groups at 6th month and 12th month after the treatment were significantly smaller than those before treatment（P<0.05）. The injury area of auricle in observed groups at 3nd month， 6th month and 12th month were significantly smaller than those in control groups（P<0.05）. The sensory abnormality rate of observed group were significantly lower than those of control groups （P<0.05）. The rate of nerve function recovery of observed group was also significantly faster than those of control group（P<0.05）. Conclusion It is important to preserve the great auricular nerve for the recovery of sensory function of the parotid gland after surgery.

[Key words] Great auricular nerve； Parotidectomy； Sensory disturbance

腮腺肿瘤是头颈部常见肿瘤，治疗方式以手术治疗为主[1]。以往手术中强调的多是对面神经的保护及肿瘤切除的彻底性，对耳大神经的保留常常被外科医生所忽视，结果导致耳大神经支配区的长期麻木[2]。随着社会的进步，在保证手术切除彻底性的同时，术后局部感觉障碍越来越被患者及手术医生所重视。我科2010年7月～2014年6月对50例腮腺良性肿瘤患者进行了保留耳大神经与不保留耳大神经随机对照研究，现报道如下。

1 资料与方法

1.1 一般资料

选取我院2010年7月～2014年6月收治的50例腮腺良性肿瘤患者，均于术前经超声、CT证实，且病理检验为单发良性肿瘤。男30例，女20例；年龄20～78岁，平均（48.8±16.2）岁。术后苏木精-伊红染色及免疫组织化学证实[3]：多形性腺瘤22例，Waithin瘤15例，基底细胞腺瘤11例，神经鞘瘤1例，囊肿1例。按入院先后顺序将患者随机分为两组各25例，两组患者一般资料比较差异无统计学意义（P>0.05），具有可比性。