内镜经口经翼下颌皱襞内侧入路的临床应用  

Clinical applications of endoscopic transoral-medial pterygomandibular fold approach

作　　者：薛凯 刘全 张焕康 赵可庆 顾晔 宋小乐 孙希才 余洪猛 XUE Kai;LIU Quan;ZHANG Huankang;ZHAO Keqing;GU Ye;SONG Xiaole;SUN Xicai;YU Hongmeng(Department of Otolaryngology,Eye&ENT Hospital,Fudan University,Shanghai,200031,China;Research Unit of New Technologies of Endoscopic Surgery in Skull Base Tumor(2018RU003),Shanghai,2()0031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院耳鼻喉科,上海200031 [2]中国医学科学院内镜下鼻颅底肿瘤外科治疗技术创新单元(2O18RUOO3),上海200031

出　　处：《中国耳鼻咽喉头颈外科》2022年第4期212-216,共5页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：中国医学科学院医学与健康科技创新工程项目(2019-I2M-5-003);上海市科学技术委员会科技创新行动计划临床医学项目(19411950600);上海市卫生局/局级项目(201940143);上海申康医院发展中心/诊疗技术项目(SHDC22021214);上海市科学技术委员会/生物医药处/西医引导项目(20Y11902000)。

摘　　要：目的 探索内镜经口经翼下颌皱襞内侧入路的临床应用。方法 收集自2021年7月~2022年1月在复旦大学附属眼耳鼻喉科医院行内镜下经口经翼下颌皱襞内侧入路手术的11例患者,统计相关临床资料,并附4例典型病例。结果11例患者为接受单纯内镜经口经翼下颌皱襞内侧入路或联合其他手术入路的病例,其中8例(72.3%)为恶性肿瘤转移至咽后淋巴结,1例(9.1%)为鼻咽癌累及咽旁间隙,1例(9.1%)为原发于咽旁间隙的良性病变,1例(9.1%)为良性病变累及咽旁间隙。9例(81.8%)患者实现了肿瘤全切,1例(9.1%)为肿瘤近全切除,1例(9.1%)为咽后淋巴结部分切除。所有病例均未出现手术相关的严重并发症。结论 内镜经口经翼下颌皱襞内侧入路可安全有效处理累及咽旁间隙、咽后间隙、颞下窝及颅底的良、恶性病变,具有重要的临床意义和广泛的应用前景。OBJECTIVE To explore the clinical applications of endoscopic transoral-medial pterygomandibular fold approach.METHODS From July 2021 to January 2022,11 patients hospitalized in the Department of Rhinology,Eye,Ear,Nose and Throat Hospital of Fudan University who underwent endoscopic transoral-medial pterygomandibular fold approach were collected.The demographic data,related history,diagnosis,treatment plan,postoperative MRI and complications of the patients were analyzed,and 4 typical cases were presented.RESULTS Of the 11 patients who underwent endoscopic transoral-medial pterygomandibular fold approach or combined with other approaches,the male to female ratio was 1.75:1,ranging in age from 32 to 64 years.Eight cases(72.3%) had a history of nasopharyngeal carcinoma and 1 case(9.1%) had a history of nasopharyngeal adenoid cystic carcinoma.Eight cases(72.3%) were malignant metastasis to retropharyngeal lymph nodes,1 case(9.1%) was nasopharyngeal carcinoma involving the parapharyngeal space,1 case(9.1%) was benign lesion originally originating in the parapharyngeal space,and 1 case(9.1%) was benign lesion involving the parapharyngeal space.Total resection was achieved in 9 cases(81.8%),near total resection in 1 case(9.1%),and partial residual retropharyngeal lymph node in 1 case(9.1%).None of the patients had any serious complications related to surgery.CONCLUSION Endoscopic transoral-medial pterygomandibular fold approach can safely and effectively deal with benign and malignant lesions involving parapharyngeal space,retropharyngeal space,subtemporal fossa and skull base.

关 键 词：颅底 翼下颌皱襞 咽旁间隙 咽后间隙 颞下窝 

分 类 号：R739.63[医药卫生—肿瘤]