咽旁隙肿瘤手术入路探讨  

Discussion on surgical approach for parapharyngeal space tumors

作　　者：罗昰 吴平[1] 何剑[1] 方兴[1] 徐婧[1] 张帅[1] 黄东海[1] 王行炜[1] 谢楚波[1] 曾俊丰 赵素萍[1] 唐瑶云[1] 

机构地区：[1]中南大学湘雅医院耳鼻咽喉头颈外科耳鼻咽喉重大疾病湖南省重点实验室,湖南长沙410008

出　　处：《中国耳鼻咽喉颅底外科杂志》2017年第3期212-216,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：国家自然科学基金(81302355)

摘　　要：目的探讨分析咽旁隙肿瘤的诊断和治疗,以提高临床手术水平,减少手术的并发症。方法本研究回顾性分析2000年1月~2012年5月收治的58例患者的临床资料,选择合适的手术途径进行治疗。手术入路有下列4种:口内径路4例,颈侧径路46例,颈腮腺径路6例,颞下窝径路2例。观察58例咽旁隙肿瘤的术后肿瘤病理类型,探讨分析58例患者术后的并发症,详细记录随访1、3、5年的远期临床疗效。结果 31例术前行CT检查,其中24例与术后病理诊断结果一致;28例患者术前行MRI检查,其中有21例与术后病理诊断一致;15例患者术前行B超检查,有8例患者与术后病理诊断结果一致。病理诊断结果发现:良性肿瘤患者44例(75.86%),恶性肿瘤14例(24.14%)。病理类型中以神经鞘瘤的比例最高。58例患者术后发生的并发症类型有术后感染、术腔积血、迷走神经损伤声带麻痹、舌咽神经麻痹、涎腺瘘、周围性面瘫以及Horner综合征。行口内径路和颈腮腺径路手术的患者发生并发症的比例较高;良性肿瘤患者术后口内径路局部复发1例,再次手术后,随访未见复发。良性肿瘤患者术后3、5年随访无因肿瘤死亡病例。恶性肿瘤患者术后复发6例,失访1例,受访者1、3、5年死亡率分别为14.29%(2/14),28.57%(4/14),42.86%(6/14)。结论术前影像学检查对咽旁隙肿瘤的诊断很重要,需外科治疗的病例手术径路非常关键。颈侧径路治疗咽旁隙肿瘤患者,术后并发症少,且疗效显著,是一种最常用而安全的手术入路方式,值得在临床上广泛推广。Objective To investigate the diagnosis and treatment of parapharyngeal space tumors in order to improve the operation level and reduce complications. Methods Clinical data of 58 patients with parapharyngeal space tumors surgically treated via appropriate surgical approaches in our hospital from Jan 2000 to May 2012 were analyzed retrospectively. Surgical approaches fell into the following four kinds ： intraoral approach （ n = 4） , lateral cervical approach （n =46）, cervical parotid approach （n = 6）, and infratemporal fossa approach （n = 2）. For all the 58 patients, postoperative pathological diagnosis of tumors were obtained, postoperative complications were analyzed, long-term follow- up results of one year, three years and five years were recorded. Results In 31 cases underwent preoperative computerized tomography （CT） , CT findings were consistent with postoperative pathological results in 24. In 28 patients underwent magnetic resonance imaging （MRI） examination, MRI findings were consistent with postoperative pathological results in 21. Ultrasonic results were in accordance with postoperative pathological diagnosis in 8 of 15 patients receiving B-ultrasonic examination. Postoperative pathological examinations confirmed benign tumors in 44 cases （75. 86% ） and malignant tumors in 14 （24.14%）. In terms of pathological types, sehwannoma accounted for the highest percentage. Postoperative complications included infection, hemorrhage, vagus nerve injury, vocal cord paralysis, salivary fistula, peripheral facial paralysis, glossopharyngeal nerve paralysis and Homer syndrome. Complications were more common in the patients surgically treated via intraoral approach and cervical parotid approach. Local recurrence occurred in one patient with benign tumor resected via intraoral approach, and no recurrence was detected after the second operation. Of the 44 patients with benign tumors, no one died of tumor within 3 years and 5 years. Of the 14 cases with malignant tumors, recurrence occur

关 键 词：咽旁隙肿瘤 病理类型 预后 手术入路 

分 类 号：R739.65[医药卫生—肿瘤]