腮腺恶性肿瘤的颞-腮腺整块切除术：手术技术

文献信息

中文摘要

目的： 晚期腮腺恶性肿瘤常延伸至颅底及邻近软组织。传统扩大腮腺切除术在实现根治性切缘方面存在局限。颞-腮腺切除术（TPR）旨在以整块方式确保标本的肿瘤学连续性，并获得可靠的手术切缘。迄今为止，文献中尚未报道该手术技术的详细描述，这是本研究的目。
方法： 2019年至2025年间，34例恶性腮腺肿瘤患者接受了TPR治疗。本文逐步详述了该手术技术。手术以颈-腮腺联合切口开始，随后根据肿瘤累及情况行全腮腺切除术，保留或牺牲面神经。整块进行选择性或改良根治性颈淋巴结清扫术。然后根据3种可重复的截骨模式行颞骨切除术：1型（部分鼓室乳突切除术，走行于面神经管外侧）；2型（部分乳突切除术，根治性鼓室切除术位于面神经管内侧、迷路外侧）；3型（根治性鼓室乳突切除术，位于面神经管内侧，并可变地延伸至蝶颞骨、迷路、颈静脉窝、颈动脉管）。腮腺、颈部和颞骨组成部分连续整块切除，不破坏标本，从而确保准确的深部切缘评估。
结果： TPR 1型实施于10例（29.4%），2型20例（58.8%），3型4例（11.8%）。结局分析超出本研究范围，将另行报告。
结论： TPR为伴颅底延伸的腮腺恶性肿瘤提供了一种可重复的整块入路，优化了肿瘤学根治性，便于手术标本的处理和评估，并使骨切除术标准化。

英文摘要

OBJECTIVE: Advanced malignant tumours of the parotid gland often extend to the skull base and adjacent soft tissues. Conventional extended parotidectomy has shown limitations in achieving radical margins. Temporo-parotid resection (TPR) was developed to ensure oncological continuity of the specimen in an en bloc fashion and to achieve reliable surgical margins. A detailed description of the surgical technique has not been reported in the literature to date and is the aim of the present work.
METHODS: Thirty-four patients with malignant parotid tumours were treated with TPR between 2019 and 2025. The surgical technique is detailed step-by-step herein. The procedure begins with a combined cervico-parotid incision, followed by total parotidectomy with preservation or sacrifice of the facial nerve according to tumour involvement. A selective or modified radical neck dissection is carried out en bloc. Temporal bone resection is then performed according to 3 reproducible osteotomy patterns: type 1 (partial tympano-mastoidectomy running lateral to fallopian canal); type 2 (partial mastoidectomy, radical tympanectomy medial to fallopian canal and lateral to the labyrinth); type 3 (radical tympano-mastoidectomy, medial to fallopian canal and variably extending to the spheno-temporal bone, labyrinth, jugular fossa, carotid canal). The parotid, neck and temporal bone components are removed in continuity, without specimen disruption, thereby ensuring accurate deep margin assessment.
RESULTS: TPR type 1 was performed in 10 cases (29.4%), type 2 in 20 cases (58.8%), and type 3 in 4 cases (11.8%). Outcome analysis was beyond the scope of the present study and will be reported separately.
CONCLUSIONS: TPR provides a reproducible en bloc approach to parotid malignancies with skull base extension, optimises oncological radicality, facilitates processing and assessment of surgical specimens, and enables standardisation of bone resections.