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目的:探讨采用电缆状耳大神经即刻移植修复腮腺癌切除术后面神经缺损的可行性。方法:因腮腺癌切除面神经后采用电缆状耳大神经移植即刻重建面神经患者11例,其中黏液表皮样癌9例,腺样囊性癌2例,均行患侧腮腺全切+肿瘤累及段面神经干及分支切除+同期电缆状耳大神经修复重建+择区性颈淋巴结清扫术。面神经缺损分为面神经干及分支、颞面干及分支和颈面干及分支3个类型;术后记录患者面部肌肉运动状态对称性及行双侧面神经肌电图检测;House-Brackmann(H-B)面神经功能分级系统评价面神经功能恢复情况。8例患者术后接受50~65Gy放疗。术后随访8~36个月,平均12个月。结果:在拟修复的面神经功能区,7例患者获得满意的闭眼功能(7/7);5例患者可见明显的皱额(5/7);9例患者静态时可获得对称的口角和鼻唇沟(9/9);4例患者放疗后3个月,面神经功能仍有明显改善。9例患者获得H-B分级Ⅱ级、2例获得Ⅲ级的康复效果。H-B分级为Ⅱ级的9例患者患侧面神经肌电活动仍较健侧轻微减弱。结论:电缆状耳大神经移植能有效修复腮腺癌切除术后面神经缺损,可作为即刻面神经缺损重建的方法。腮腺区的游离神经移植可能不是术后放疗的禁忌证。
OBJECTIVE: To investigate the feasibility of repairing the facial nerve defect after resection of parotid gland carcinoma by immediate cable-like large nerve graft. Methods: Eleven patients with facial nerve were repaired immediately after the excision of the facial nerve by cable-like large ear nerve. The mucoepidermoid carcinoma in 9 cases and adenoid cystic carcinoma in 2 cases were all performed in the affected parotid gland. The tumor involved the facial nerve Dry and branch removal + Cable-like ear large nerve repair and reconstruction + selective neck dissection in the same period. Facial nerve defects were divided into facial nerve trunk and branch, temporal trunk and branch and neck trunk and branch three types; postoperative patients facial muscle motion symmetry and line bilateral facial nerve electromyography detection; House-Brackmann (HB) Facial nerve function grading system to evaluate facial nerve function recovery. Eight patients received 50-65 Gy postoperative radiotherapy. The patients were followed up for 8 to 36 months with an average of 12 months. RESULTS: In the facial nerve functional areas to be repaired, satisfactory closed-eye function (7/7) was obtained in 7 patients; significant wrinkles (5/7) were observed in 5 patients; symmetrical mouth-to-mouth and Nasolabial fold (9/9); 4 patients 3 months after radiotherapy, facial nerve function is still significantly improved. Nine patients had grade H-B grade II and two received grade III rehabilitation. Nine patients with H-B grade Ⅱ were still slightly weaker than those of the uninjured side. CONCLUSION: Cable-like large ear nerve transplantation can effectively repair facial nerve defect after resection of parotid gland carcinoma and can be used as a method of immediate facial nerve defect reconstruction. Free nerve graft in the parotid gland area may not be a contraindication to postoperative radiotherapy.