经口径路切除巨大咽旁间隙良性肿瘤  

Resection of macrosis benign parapharyngeal neoplasms via oral approach

作　　者：李树华[1] 石洪金[1] 吴大海[1] 

机构地区：[1]解放军沈阳军区总医院耳鼻咽喉科,110840

出　　处：《中华耳鼻咽喉头颈外科杂志》2014年第10期844-847,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的 探讨经口径路切除巨大咽旁间隙良性肿瘤的可能性,总结手术经验.方法 回顾性分析2005年1月至2012年12月间在沈阳军区总医院临床初诊为咽旁间隙肿瘤的16例患者,术前进行CT、MRI和CT血管成像检查,对肿瘤包膜完整、肿瘤主体位于颈部大血管内侧的患者,行内镜和等离子手术系统辅助下经口径路肿瘤切除术.结果 经过筛选符合条件的巨大咽旁间隙肿瘤患者16例,肿瘤最大径均＞5 cm,患者均在内镜、电凝或等离子手术系统辅助下经口径路完整切除咽旁间隙肿瘤,其中气管切开4例.术后均恢复良好,无明显并发症.术后病理诊断多形性腺瘤9例,神经鞘瘤5例,神经纤维瘤2例.随访12个月至8年,中位随访时间31个月.1例神经纤维瘤复发,后经颈侧切开切除肿瘤治愈其余15例无复发.结论 经过严格选择的巨大咽旁间隙肿瘤可以在内镜和等离子手术系统的辅助下经口径路完整切除,该手术方法具有创伤小、安全性良好、并发症少、疗效确切的优点.Objective To explore investigate the feasibility of transoral removal of macrosis benign neoplasms in parapharyngeal space.Methods Sixteen patients with well-defined macrosis benign parapharyngeal space tumors treated by surgery from January 2005 to December 2012 were enrolled in this study.All patients were assessed by CT scan,MRI and CT angiography before surgery.Surgery for the tumors with complete peplos,locating at medial side of carotid and accessible from the oropharynx was completed with the assistance of endoscope,bipolar electrocoagulation or radiofrequency ablation system.Results All neoplasms were removed by transoral approach.Tracheotomy was performed in 4 cases.All patients were treated successfully with good postoperative recovery and no significant complications.Postoperative pathological examination showed there were 9 cases of pleomorphic adenoma,5 cases of neurilemmoma and 2 cases of neurofibroma.By the follows-up of 1-8 years （median 31 months）,among 16 cases only one case of neurofibroma recurred.Conclusion The transoral removal of macrosis benign neoplasms in parapharyngeal space is safe,manimally invasive and feasible in selected cases,with a high local control rate and a low surgical complication rate.

关 键 词：头颈部肿瘤 肿瘤 多形性 神经鞘肿瘤 耳鼻喉外科手术 

分 类 号：R739.6[医药卫生—肿瘤]