不同手术径路治疗咽旁间隙肿瘤的回顾性分析  

Retrospective analysis of parapharyngeal space tumors treated by different surgical pathways

作　　者：张达 张亮[1] 刘业海[1] 童步升[1] ZHANG Da;ZHANG Liang;LIU Yehai;TONG Busheng(Department of Otolaryngology,The First Affiliated Hospital of Anhui Medical University,Hefei,Anhui,230022,China)

机构地区：[1]安徽医科大学第一附属医院耳鼻咽喉科,合肥230022

出　　处：《中国中西医结合耳鼻咽喉科杂志》2024年第3期209-216,共8页Chinese Journal of Otorhinolaryngology in Integrative Medicine

摘　　要：目的总结并分析咽旁间隙肿瘤的临床特征、手术径路及预后,探讨不同手术径路治疗咽旁间隙肿瘤的优缺点。方法回顾性分析2018年9月~2022年10月安徽医科大学第一附属医院收住的44例咽旁间隙肿瘤患者的临床资料,所有患者术前都行CT和(或)MRI检查,所采用的手术径路如下:下颌骨劈开入路1例,经颈侧入路19例,经颈-腮腺入路7例,内镜辅助颈外入路1例,经口-颈侧联合入路2例,内镜下经口入路12例,经鼻内镜入路2例。结果术后组织病理类型丰富,其中良性肿瘤41例(93.2%),恶性肿瘤3例(6.8%),术后发生并发症13例,最常见的并发症为神经受损引起的症状;良性肿瘤随访8~56个月,其中1例神经鞘瘤术后复发两次,三次手术后治愈;恶性肿瘤随访18~54个月,2例术后行辅助放化疗,其中1例死亡;1例规律随访,未见复发。结论咽旁间隙是一个复杂的解剖区域,原发性咽旁间隙肿瘤绝大部分为良性肿瘤,早期多无特异性症状,病理类型多样。治疗上首选手术切除,术前的影像学检查对诊断是必需的,可以根据肿瘤的大小、形态、解剖位置以及与血管的关系选择等合适的手术径路完整切除肿瘤,总体预后较好。Objective To summarize and analyze the clinical features,surgical approaches and prognosis of paraphary-ngeal space tumors,and to discuss the advantages and disadvantages of different surgical approaches in the treatment of parapharyngeal space tumors.Methods Retrospective analysis of the clinical data of 44 patients with parapharyngeal space tumors admitted to the First Affiliated Hospital of Anhui Medical University from September 2018 to October 2022 was completed,and all patients underwent preoperative CT and/or MRI examination.The surgical approaches used were as follows:mandibular split approach in 1 case,lateral transcervical approach in 19 cases,transcervical-parotid approach in 7 cases,endoscopic-assisted external cervical approach in 1 case,combined transoral-lateral cervical approach in 2 cases,endoscopic transoral approach in 12 cases and transnasal endoscopic approach in 2 cases.Results Postoperative histopathological types were abundant,including 41 cases(93.2%)of benign tumours and 3 cases(6.8%)of malignant tumours.Thirteen cases of postoperative complications occurred,and the most common complication is nerve damage.Benign tumours were followed up from 8 to 56 months,including one case of nerve sheath tumour that recurred twice after surgery and was cured after three operations.Malignant tumours were followed up from 18 to 54 months,with two cases undergoing adjuvant postoperative chemoradiotherapy.One of them died and one case was followed up regularly and no recurrence was seen.Conclusion The parapharyngeal space is a complex anatomical area and the vast majority of primary parapharyngeal space tumours are benign,with no specific symptoms in the early stages and a variety of pathological types.Preoperative imaging is necessary for diagnosis,and a suitable surgical route can be chosen for complete resection of the tumour according to its size,morphology,anatomical location and relationship with blood vessels.

关 键 词：咽旁间隙肿瘤 手术径路 临床特征 影像学检查 

分 类 号：R739.63[医药卫生—肿瘤]