下颌骨外旋径路切除鼻咽、口咽、咽旁间隙肿瘤——附12例报道  

Resection of tumors in nasopharynx,oropharynx,and parapharyngeal space via mandibullar swing approach(reports of 12 cases)

作　　者：姜彦[1] 董频[1] 李晓艳[1] 徐宏鸣[1] 朱宽龙 

机构地区：[1]上海交通大学附属上海市第一人民医院耳鼻咽喉头颈外科,上海200080 [2]浙江省宁波市象山红十字台胞医院耳鼻咽喉头颈外科,浙江宁波315731

出　　处：《中国耳鼻咽喉颅底外科杂志》2007年第3期189-192,共4页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的探讨鼻咽、口咽、咽旁间隙肿瘤的手术方法。方法对2002年-2006年下颌骨外旋径路手术切除肿瘤并行局部修复治疗的3例鼻咽癌（2例放疗后复发,1例下咽癌术后鼻咽、口咽部巨大重复癌）、5例口咽恶性肿瘤（3例扁桃体鳞癌,2例颊黏膜鳞癌）、4例咽旁间隙肿瘤（1例脂肪瘤,3例混合瘤恶变）进行回顾性分析。术后缺损分别用胸大肌皮瓣修补3例,用游离前臂皮瓣修补4例,组织工程补片修复2例。结果随访8个月至4年,3例鼻咽癌患者中1例术后1年远处转移死亡,2例无瘤生存;3例扁桃体癌中2例无瘤生存,1例局部复发再次手术切除;2例颊黏膜鳞癌无瘤生存;1例脂肪瘤无复发,3例混合瘤恶变患者中1例6个月后死于远处转移,1例带瘤生存,1例无瘤生存。结论下颌骨外旋径路对于暴露鼻咽、口咽、咽旁间隙肿瘤视野良好,肿瘤可直视下完整切除,应用组织工程补片、带蒂或游离组织瓣进行I期修复,手术安全、可靠。Objective To seek for an appropriate surgical approach for the resection of tumors in nasopharynx, oropharynx and parapharyngeal space. Methods Clinical data of 12 patients with tumors resected via mandibular swing approach （MSA） from 2002 to 2006 were studied retrospectively. As for the position of the tuomrs, 3 tumors were located at nasopharynx, 5 at oropharynx, and 4 in parapharyngeal space. Except for the resection of tumors, 5 patients received retropharyngeal node dissection, 2 received unilateral modified radical neck dissections, 3 patients with oropharyngeal defect were reconstructed with the pectoralis major myocutaneous flap, 4 cases were reconstructed with the forarm free flap and 2 cases with tissue engineering flap. The patients with malignant tumors were given postoperative radiotherapy. Results AU patients were followed up for 8 months to 4 years. One nasopharyngeal carcinoma patient died of lung metastasis one year after surgery, and one with tumor of parapharyngeal space died of tumor recurrence 6 months after surgery. One tonsillar carcinoma patient recurred and received the second operation. The others were alive. Conclusion MSA providesa maximal exposure of the the nasopharynx, oropharynx, and the parapharyngeal space. It allows thorough resection of the tumor, and facilitates the immediate rehabilitation with artificial tissue, free flap, or myocutaneous flap. MSA is safe and effective.

关 键 词：下颌骨外旋 鼻咽肿瘤 咽旁肿瘤 外科皮瓣 

分 类 号：R739.63[医药卫生—肿瘤]