颈侧切治疗原发性咽旁间隙巨大良性肿瘤  

Transcervical approach resects primary parapharyngeal space major tumors

作　　者：崔萌 娄卫华 巴云鹏 桑建中 

出　　处：《中国实用医刊》2009年第7期42-43,45,共3页Chinese Journal of Practical Medicine

摘　　要：目的探讨原发于咽旁较大肿瘤的手术颈侧入路及诊疗体会，进一步指导临床工作。方法回顾分析咽旁间隙肿瘤患者的临床资料及手术路径。咽旁良性肿瘤直径〉10cm的患者中，神经鞘膜瘤12例，副神经节瘤6例，多形性腺瘤3例，2例鞘膜瘤沟通颅内外。手术采用颈侧入路、颈腮腺入路。结果21例患者中19例完整切除，2例部分切除。1例术后出现颈静脉孔综合征，1例术后出现声音嘶哑，2例术后出现霍纳综合征。随访1～5年，无复发。结论术前行CT、MRI检查对咽旁间隙肿瘤治疗方案和手术径路的选择有重要意义。肿瘤较大并与颅底血管神经关系密切并非是颈侧入路的禁忌证。只要稍加改动也可做到安全、有效、简捷、微创，我们尝试经颈侧入路切除累及颅底血管神经区的较大肿瘤，初步结果满意。Objective To evaluate the cervical approach, the diagnosis and therapeutic experience of primary parapharyngeal space（PPS） major tumor for further guidance of clinical work. Methods The clinical data and surgical approach of patients with PPS tumors were restrospectively analyzed. Among the patients with PPS tumor more than 10 cm in diameter, 12 were schwannoma,6 were ganglion and 3 were pleomorphic adenoma. 2 cases of schwannoma were in both intracalvarium and outside. Transcervical approach and transparotid approach were applied. Rusults In 21 cases, 19 cases underwent complete resection and 2 cases underwent partial resection. Jugular foramen syndrome was acquired in 1 case after operation. Hoarse voice happened in 1 case during operation. Hornet＇ s syndrome was found in 2 cases after operation. During a follow -up of 1 to 5 years, no recurrence. Conclusions CT and MRI before operation are valuable to the treatment and selection of surgical approach of PPS tumors. It is no contraindication for transcervical approach that tumor has an intimate relationship for basilar region, vaso -nerves area and a major volume. The transcervical approach is a simple, safe, minimal invasive and effective procedure for basilar region major tumors as long as we modified on operation slightly, and the outcome is satisfactory.

关 键 词：咽旁肿瘤 颈侧入路 手术方式 

分 类 号：R73[医药卫生—肿瘤]