原发性咽旁间隙肿瘤91例临床分析  

Clinical analysis of 91 cases of primary parapharyngeal space tumors

作　　者：孙丰林[1,2] 金童[1] 李文明[1] 钱晔[1] 魏东敏[1] 孙睿杰[1] 刘大昱[1] 解光[1] 雷大鹏[1] 潘新良[1] 

机构地区：[1]山东大学齐鲁医院耳鼻咽喉科卫生部耳鼻咽喉科学重点实验室,济南250012 [2]山东省淄博市中心医院耳鼻咽喉头颈外科

出　　处：《中华耳鼻咽喉头颈外科杂志》2014年第4期305-310,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：山东省科技发展计划项目（2009GG10002018）

摘　　要：目的 总结并分析原发性咽旁间隙肿瘤的临床特征、诊断方法、手术入路及预后.方法 回顾性分析1999年1月至2011年12月收治的91例原发性咽旁间隙肿瘤患者的临床资料.所有患者均行术前增强CT检查,7例另行MRI检查,并依据影像检查结果制定手术方案.手术入路方式为经颈外入路73例,经腮腺入路5例,经口入路5例,经下颌骨裂开8例.结果 本组患者术后病理诊断良性肿瘤20种,恶性肿瘤9种.80例良性肿瘤术后6例失访,74例随访31～84个月无复发.11例恶性肿瘤随访8～51个月,中位随访29个月,7例死亡,1例失访.本组患者术后并发霍纳综合征3例,声音嘶哑2例,舌下神经麻痹1例,副神经麻痹1例,上气道梗阻1例,颈内动脉-海绵窦瘘1例.结论 咽旁间隙肿瘤少见,临床表现不典型,病理类型多样化;CT和（或）MRI有助于评估肿瘤的大小、位置及可能的来源和手术方案的制定.手术切除是主要治疗方式,单纯颈外入路可切除绝大多数肿瘤.咽旁间隙良性肿瘤预后好,恶性肿瘤预后差.Objective To summarize and analyze the clinical features,diagnosis methods,surgical approaches and treatment outcomes of patients with primary parapharyngeal space tumors.Methods A retrospective review of 91 cases with primary parapharyngeal space tumors treated from January 1999 to December 2011 was performed.All patients underwent preoperative enhanced CT scan and postoperative histopathologic examination.Intraoperative frozen section biopsies were performed in 36 of 91 cases.The surgical approaches included trans-cervical approach in 73 cases,trans-parotid approach in 5 cases,transoral approach in 5 cases,and mandibulotomy in 8 cases.Results The postoperative pathological diagnoses consisted of 29 variants,including 20 for benign tumors and 9 for malignant tumors.Of the 80 cases with benign tumors,6 cases were lost to follow-up and 74 cases were followed up for 31-84 months with no recurrence.Eleven cases with malignant tumor were followed up for 8-51 months （median 29 months）,of them 7 cases died and 1 case was lost to follow-up.The post-operative complications included Horner syndrome in 3 cases,hoarseness in 2 cases,hypoglossal nerve palsy in 1 case,accessory nerve palsy in 1 case,upper airway obstruction in 1 case,and internal carotid artery cavernous sinus fistula in 1 case.Conclusions Parapharyngeal space tumors are rare,with atypical clinical manifestation,and have pathological types of diversification.CT or MRI is helpful to evaluate the tumor size,location and possible sources,and to make operation scheme.Surgery is the first choice for parapharyneal space tumors.Transcervical approach can be applied to most tumors.Parapharyngeal benign tumors have good prognosis,but malignant tumors have poor prognosis.

关 键 词：头颈部肿瘤 诊断 耳鼻喉外科手术 

分 类 号：R739.63[医药卫生—肿瘤]