2种手术入路在巨大咽旁间隙肿瘤切除术中的效果比较  

Endoscopy-assisted transoral versus endoscopy-assisted transcervical minimal incision plus mandibular osteotomy approach in resection of large parapharyngeal space tumors

作　　者：黄卓珊[1] 张大明[1] 陈伟良[1] 黄志权[1] 范松[1] 

机构地区：[1]中山大学孙逸仙纪念医院口腔颌面外科,广东广州510120

出　　处：《中国口腔颌面外科杂志》2018年第1期56-59,共4页China Journal of Oral and Maxillofacial Surgery

摘　　要：目的 :比较内镜辅助下2种手术入路在巨大咽旁间隙肿瘤切除术中的临床效果。方法 :收集23例行巨大咽旁间隙肿瘤内镜辅助下切除术患者(男15例,女8例),11例经口入路(endoscopy-assisted transoral,ETO),12例经颈小切口联合下颌支垂直骨离断术(endoscopy-assisted transcervical minimal incision plus osteotomy of the vertical ramus outside the mandibular foramen,ETC+MO),比较2种手术入路的临床效果。结果 :ETO组患者均为良性肿瘤,ETC+MO组有2例腺样囊性癌和1例复发性多形性腺瘤。所有肿瘤均完整切除、无破裂。所有患者均无严重并发症。ETC+MO组有1例出现暂时性面神经轻瘫,术后8周自发性缓解。ETO组所有患者和ETC+MO组10例患者均获得理想的面部美学保存效果。经7~26个月随访,所有患者均无复发。结论:ETO和ETC+MO入路均为安全可靠的切除咽旁间隙巨大肿瘤的手术方法,且术后均可获得良好的功能和美观效果。2组比较,ETO组住院时间较短,可避免下颌神经损伤危险,ETC+MO组则更适用于晚期、复发性咽旁间隙肿瘤。PURPOSE： To evaluate the outcome of endoscopy-assisted transoral（ETO） approach for resection of parapharyngeal space tumors compared to endoscopy-assisted transcervical minimal incision plus osteotomy of the vertical ramus outside the mandibular foramen approach（ETC＋MO）. METHODS： Twenty-three consecutive patients （15 males, 8 females） who underwent resection of large parapharyngeal space tumors via ETO approach or ETC＋MO approach were analyzed retrospectively. RESULTS： The tumors in ETO group were benign; there were 2 patients with adenoid cystic carcinoma and 1 patient with recurrent pleomorphic adenoma in ETC＋MO group. All tumors were removed completely without rupture. No major complications developed in any patient. Temporary facial paresis occurred in 1 patient in the ETC＋MO group, which resolved spontaneously within 8 weeks. The cosmetic effects of all patients in ETO groups and 10 patients in ETC＋MO groups were excellent. Patients were followed up for 7-26 months, no recurrence was encountered. CONCLUSIONS： ETO and ETC＋MO approach in resection of large parapharyngeal space tumors are feasible and safe, which can achieve excellent aesthetic and functional results. ETO approach can shorten hospitalized time and avoid the risk of marginal mandibular nerve injury and ETC＋MO approach may be used in resection of malignant or recurrent parapharyngeal space tumors.

关 键 词：内镜 咽旁间隙 肿瘤 经口入路 经颈入路 下颌骨离断术 

分 类 号：R739.8[医药卫生—肿瘤]