等离子及内镜系统辅助下口内径路治疗咽旁间隙肿瘤疗效分析  

Analysis of efficacy of coblation assisted endoscope system for the treatment of parapharyngeal space tumors with transoral approach

作　　者：龚霄阳 卫亚楠 林子萍[1] 乔明哲[1] 董伟达[1] 徐进[1] 陈海兵[1] 陈曦[1] GONG Xiaoyang;WEI Ya’nan;LIN Ziping;QIAO Mingzhe;DONG Weida;XU Jin;CHEN Haibing;CHEN Xi(Department of Otorhinolaryngology,the First Affiliated Hospital,Nanjing Medical University,Nanjing,210029,China)

机构地区：[1]南京医科大学第一附属医院,江苏省人民医院耳鼻咽喉科,南京210029

出　　处：《临床耳鼻咽喉头颈外科杂志》2021年第3期204-208,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：江苏省卫生健康委科研课题(No:H2018013)。

摘　　要：目的:探讨在等离子及内镜系统的辅助下口内径路咽旁间隙肿瘤手术的可行性、安全性及有效性。方法:回顾性分析20例咽旁间隙肿瘤患者的临床资料,术前均行CT和(或)MRI检查,均在等离子及内镜系统辅助下进行口内径路手术。术后密切随访,随访时间为8~56个月,中位随访时间为28个月。结果:20例患者中良性肿瘤共18例(90%),恶性肿瘤2例(10%),肿瘤最大直径(4.4±1.6) cm,手术时间(79.00±30.03) min,术中出血量(23.63±22.20) mL,术后疼痛VAS评分2.8±1.4。17例完整切除,3例术后复发,包括1例滑膜肉瘤远处转移后死亡患者。2例出现术后并发症,1例神经纤维瘤出现声音嘶哑,1例神经鞘瘤出现伸舌偏斜。结论:等离子及内镜系统辅助下口内径路治疗咽旁间隙肿瘤具有颈部不留瘢痕、患者易于接受、术中出血少、手术时间短、术后反应轻、恢复快等特点。但对原发恶性病变,广泛或高度血管化的病变,肿瘤位于颈内动脉外侧、上极与颅底距离小于2 cm或向外侧侵犯腮腺深叶,术前或术中考虑多形性腺瘤较大无法完整切除时,仍建议行外部入路手术。Objective: To summarize and analyze the feasibility, safety and efficacy of parapharyngeal space surgery assisted by coblation and endoscopic system with transoral approach. Methods: The data of 20 patients with parapharyngeal space tumors were retrospectively analyzed. All the patients underwent CT and/or MRI examination before surgery, and all underwent transoral approach assisted by coblation and endoscopic systems. The patients were followed up strictly after the operation, with a follow-up time of 8-56 months and the median follow-up time of 28 months. Results: Among the 20 patients, 18(90%) were pathologically benign tumors and 2(10%) were malignant tumors. The maximum tumor diameter was(4.4±1.6) cm, the operative time was(79.00±30.03) min, the intraoperative blood loss was(23.63±22.20) mL, and the postoperative pain VAS score was 2.8±1.4. There were 17 cases complete resection, and 3 cases of relapse, including 1 patient who died after distant metastasis of synovial sarcoma postoperative complications occurred in 2 cases, hoarseness in 1 case of neurofibroma and tongue extension deflection in 1 case of schwannoma. Conclusion: Coblation assisted endoscopic system for the treatment of parapharyngeal space tumors with transoral approach has no cervical scar, which is a satisfaction for the patients, less intraoperative bleeding, short operative time, mild postoperative reaction and quick recovery. However, external approach is still recommended for primary malignant lesions, extensive or highly vascularized lesions, tumors located on the lateral side of the internal carotid artery, less than 2 cm from the skull base, or lateral invasion of the deep lobe of the parotid gland, or a pleomorphic adenoma is considered or is found to be too large to be completely resected preoperatively or intraoperatively.

关 键 词：咽旁间隙肿瘤 口内径路 等离子 内镜系统 

分 类 号：R73963[医药卫生—肿瘤]