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北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (2): 334-339. doi: 10.19723/j.issn.1671-167X.2025.02.018

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部分下颌下腺切除术治疗下颌下腺良性肿瘤的临床效果

杨源源1,2, 张珊珊2, 俞光岩3, 杨辉俊2,*(), 杨宏宇2,*()   

  1. 1. 北京大学口腔医学院·口腔医院综合二科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，口腔数字医学北京市重点实验室，北京 100081
    2. 北京大学深圳医院口腔医学中心口腔颌面外科，广东省高水平临床重点专科，广东省口腔疾病诊疗技术工程技术研究中心，广东深圳 518036
    3. 北京大学口腔医学院·口腔医院口腔颌面外科，北京 100081
  • 收稿日期:2022-06-27 出版日期:2025-04-18 发布日期:2025-04-12
  • 通讯作者: 杨辉俊,杨宏宇 E-mail:yanghj8801019@163.com;hyyang192@hotmail.com
  • 基金资助:
    深圳市医疗卫生三名工程(SZSM202111012);广东省高水平临床重点专科(SZGSP008);深圳市卫生计生系统科研项目(SZXJ2018078)

Clinical outcomes of partial sialoadenectomy for the treatment of benign tumors in the submandibular gland

Yuanyuan YANG1,2, Shanshan ZHANG2, Guangyan YU3, Huijun YANG2,*(), Hongyu YANG2,*()   

  1. 1. Department of General Dentistry Ⅱ, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Department of Oral and Maxillofacial Surgery, Stomatological Center, Peking University Shenzhen Hospital & Guangdong Province High-level Clinical Key Specialty & Guangdong Province Engineering Research Center of Oral Disease Diagnosis and Treatment, Shenzhen 518036, Guangdong, China
    3. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
  • Received:2022-06-27 Online:2025-04-18 Published:2025-04-12
  • Contact: Huijun YANG, Hongyu YANG E-mail:yanghj8801019@163.com;hyyang192@hotmail.com
  • Supported by:
    the Sanming Project of Medicine in Shenzhen(SZSM202111012);Shenzhen Fund for Guangdong Provincial High-level Clinical Key Specialties(SZGSP008);Shenzhen Health and Family Planning System Research Project(SZXJ2018078)

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摘要：

目的: 分析部分下颌下腺切除术对于下颌下腺良性肿瘤治疗的临床效果，探讨部分下颌下腺切除术的应用价值。方法: 纳入2017年10月至2021年2月于北京大学深圳医院口腔颌面外科行手术治疗的下颌下腺多形性腺瘤患者并对其进行随访评估，其中15例行部分下颌下腺切除术(部分切除组)，18例行常规下颌下腺切除术(全切除组)，比较两组术后唾液分泌、口干程度、面颈部容貌、神经损伤、肿瘤复发情况，并分析部分切除组健侧和患侧腺体体积、唾液流率及两者之间的相关性。结果: 两组患者在随访期内均未见肿瘤复发。部分切除组及全切除组术后静息全唾液流率分别为(2.15±1.10) g/5 min及(1.35±0.97) g/5 min，差异有统计学意义(t=2.208，P=0.035)，口干症状部分切除组较全切除组轻(Z=-2.244，P=0.025)；在部分切除组中，同一患者健侧和患侧下颌下腺静息唾液流率分别为(1.18±0.40) g/5 min及(0.92±0.40) g/5 min，差异有统计学意义(t=-2.821，P=0.014)，而当患侧腺体剩余80%以上时，健侧和患侧静息唾液流率差异无统计学意义(t=-0.027，P=0.980)，单位体积腺体唾液流率健侧和患侧差异无统计学意义(t=-0.015，P=0.989)，剩余腺体的体积与唾液流率呈正相关(r=0.750，P=0.012)。部分切除组术后容貌满意度略高于全切除组，但差异无统计学意义；两组术后均未出现神经损伤症状。结论: 部分下颌下腺切除术在根治良性肿瘤的同时保留腺体分泌功能，并发症更少，可以提高患者生活质量。

关键词: 下颌下腺良性肿瘤, 部分腺体切除术, 功能性唾液腺外科, 治疗效果

Abstract:

Objective: To evaluate the clinical outcomes and explore the application of partial sialoadenectomy for the treatment of benign tumors in the submandibular gland (SMG). Methods: Patients with pleomorphic adenoma of the SMG who underwent surgical treatment in the Department of Oral and Maxillofacial Surgery, Peking University Shenzhen Hospital, from October 2017 to February 2021, were enrolled and assessed in the follow-up. Fifteen patients underwent partial sialoadenectomy (PS group), and 18 patients underwent total sialoadenectomy (TS group). Postoperative salivary secretion, degree of dry mouth, appearance changes of the face and neck, nerve damage, and tumor recurrence were compared between the groups. The volume of the glands on the operated and contralateral sides of the patients in the PS group, the saliva flow rate, and their correlations, were also analyzed. Results: There was no recurrence during the follow-up period. The whole saliva flow rate at rest in the PS group was higher than that in the TS group [(2.15±1.10) g/5 min vs. (1.35±0.97) g/5 min, t=2.208, P=0.035)], while the stimulated saliva flow rate was not significantly different. The objective feeling of dry mouth, evaluated by visual analogue scale (VAS) score, was more obvious in the TS group than in the PS group (Z=-2.244, P=0.025). In the PS group, the resting saliva flow rate of the SMG on the operated side was lower than that on the contralateral side of the same patient [(0.92±0.40) g/5 min vs. (1.18±0.40) g/5 min, t=-2.821, P=0.014], however, in the cases whose remaining SMG was more than 80% of the contralateral side, the saliva flow rate of both sides was not significantly different (t=-0.027, P=0.980). There was no significant difference in the saliva flow rate per unit volume of the gland on either side (t=-0.015, P=0.989), and the saliva flow rate of the operated SMG was positively correlated with the volume of the remaining gland (r=0.750, P=0.012). The VAS scores for neck deformity were not significantly different between the two groups (t=-0.997, P=0.319). No symptoms of nerve injury occurred in either group. Conclusion: Partial sialoadenectomy in the SMG can safely remove benign tumors while preserving glandular secretory function, with fewer complications and improved quality of life.

Key words: Benign tumor of submandibular gland, Partial sialoadenectomy, Gland-preserving surge-ry, Treatment outcome

中图分类号: 

  • R782.7

图1

部分下颌下腺切除的主要手术步骤"

图2

部分下颌下腺切除术后健侧和患侧腺体重建图像"

表1

两组术后下颌下腺功能及并发症发生情况"

Items Partial sialoadenectomy (n=15) Total sialoadenectomy (n=18) Statistics P value
Flow rate of whole saliva/(g/5 min)
  Rest 2.15±1.10 1.35±0.97 t=2.208 0.035
  Stimulated 10.63±5.67 8.12±3.96 t=1.493 0.146
VAS score
  Dry mouth 0 (0-1) 1 (0-2) Z=-2.244 0.025
  Neck deformity 2 (1-3) 2 (1-3) Z=-0.997 0.319
Nerve damage/% 0 0

表2

部分下颌下腺切除术后健侧和患侧腺体体积及唾液流率"

Items n Operated SMG Contralateral SMG t P value
Volume of gland/cm3 10 3.60±2.31 4.67±2.29 -3.996 0.003
Saliva flow rate/(g/5 min) 15 0.92±0.40 1.18±0.40 -2.821 0.014
Saliva flow rate of per unit volume/[g/(cm3·5 min)] 10 0.32±0.18 0.32±0.18 -0.015 0.989

图3

部分下颌下腺切除术后腺体体积与患侧唾液流率相关性"

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ISSN 1671-167X
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