咽旁间隙肿瘤不同手术入路选择策略及疗效分析  

Selection strategy and curative effect analysis of different surgical approaches for parapharyngeal space tumor

作　　者：凌志明 曾泉[1] LING Zhiming;ZENG Quan(Department of Otolaryngology,the First Affiliated Hospital of Chongqing Medical University,Chongqing,400016,China)

机构地区：[1]重庆医科大学附属第一医院耳鼻咽喉科,重庆400016

出　　处：《中国耳鼻咽喉头颈外科》2023年第9期545-550,共6页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的分析咽旁间隙肿瘤不同手术入路的选择策略及其疗效,为其诊疗提供参考。方法回顾性分析2014年1月~2021年6月于重庆医科大学附属第一医院耳鼻咽喉科接受手术治疗的53例咽旁间隙肿瘤患者的临床资料和随访结果,依据CT/MRI评估肿瘤大小与位置,包括与茎突、颈内动脉、颅底、硬腭及腮腺的关系。结果53例患者中,1例双侧发病。采用内镜辅助下的经口入路15例、经颈入路9例、经口经颈联合入路2例、经鼻入路3例,传统经颈入路25例。茎突前与茎突后的肿瘤症状(χ^(2)=27.50,P<0.001)和病理类型(χ^(2)=27.28,P<0.001)差异有统计学意义,不同手术入路的肿瘤与茎突(χ^(2)=18.78,P<0.001)、颈内动脉(χ^(2)=11.57,P=0.009)、腮腺(χ^(2)=10.64,P=0.015)的关系差异有统计学意义,而手术时间(H=7.46,P=0.113)、术中出血量(H=7.51,P=0.111)、完整切除率(χ^(2)=5.02,P=0.261)及术后并发症发生率(χ^(2)=5.49,P=0.207)无明显差异。7组配对分析中观察到内镜辅助下经口入路术中出血量(Z=-0.845,P=0.398)和术后住院天数(Z=-0.315,P=0.752)较传统经颈入路更少,但统计学差异并不显著。结论内镜辅助下切除咽旁间隙肿瘤的适应证已经得到了扩展,应针对肿瘤的性质、体积及位置延伸选择合理的手术方式,在保证手术疗效的同时尽可能降低手术创伤。OBJECTIVE Aimed to evaluate the strategies and the efficacy of different surgical approaches for parapharyngeal space tumors,and to provide a reference for their diagnosis and treatment.METHODS We retrospectively analyzed the data of 53 patients treated surgically for parapharyngeal space tumors at our center from January 2014 to June 2021,CT/MRI were used to assess tumor size and location,including the relationship between the tumor and the styloid process,the internal carotid artery,the skull base,the hard palate,and the parotid gland.RESULTS Of the 53 patients,1 patient had bilateral lesions.Endoscopic-assisted transoral,transcervical,transoral-cervical,and transnasal approaches were used in 15,9,2,and 3 cases,respectively,and traditional transcervical approach was used in 25 cases.The pre-styloid and post-styloid tumors differed statistically significantly in symptoms(χ^(2)=27.50,P<0.001)and histology(χ^(2)=27.28,P<0.001).The differences between different surgical accesses were statistically significant for the relationship between the tumor and the styloid process(χ^(2)=18.78,P<0.001),internal carotid artery(χ^(2)=11.57,P=0.009),and parotid gland(χ^(2)=10.64,P=0.015),while there were no differences in operation time(H-7.46,P=0.113),intraoperative blood loss(H-7.51,P=0.111),complete resection rate(χ^(2)=5.02,P=0.261),and postoperative complication rate(χ^(2)=5.49,P-0.207).Less intraoperative bleeding(Z=-0.845,P=0.398)and duration of postoperative hospitalization(Z=-0.315,P-0.752)were observed in the endoscopic transoral approach than in the conventional transcervical approach in the 7-group matched-pair analysis,although the statistical differences were not significant.CONCLUSION To ensure surgical efficacy while reducing surgical trauma,a reasonable surgical approach should be selected according to the type,size,location,and extent of the tumor.

关 键 词：外科手术 治疗结果 咽旁间隙肿瘤 微创手术 手术入路 内镜辅助 

分 类 号：R739.63[医药卫生—肿瘤]