咽旁肿瘤切除术(附29例)

The study of parapharyngeal space tumorectomy

目的探讨如何根据术前诊断选择最佳的手术进路，提高疗效，减少并发症和后遗症。方法本组29例，男性16例，女性13例，年龄18～57岁，中位年龄45。均采用手术治疗及术后化疗或放疗。手术进路：口腔入路、颌颈入路、颈侧高位切开下颌骨外旋入路、颌咽入路、上颌骨掀翻入路、上颌骨加咽旁肿瘤切除。结果病理类型：良性21例，恶性8例，随访5年，良性肿瘤均未见复发，骨肉瘤1例术后2个月复发，上颌窦癌1例术后2年复发，口咽侧壁粘液表皮样癌1例术后6年复发，再次术后2年复发，颌下腺腺样囊性癌术后4年复发并肺转移，未继续治疗，恶性淋巴瘤2例化疗后5年无复发。手术均未出现并发症，术后有暂时性的神经功能障碍，均在半年内恢复。结论口腔入路仅适用于紧邻咽粘膜下小肿瘤、颌颈入路适用于咽旁混合瘤、神经鞘瘤和颈动脉体瘤、颈侧高位切开下颌骨外旋入路适用于腮腺深叶肿瘤及高位神经鞘瘤、颌咽入路适用于恶性肿瘤连同下颌升枝一并切除、上颌骨掀翻入路及上颌骨适用于晚期的上颌窦癌及颅底肿瘤侵入咽旁。

Objective To study how to select the best surgical approach according to the preoperative diagnosis, in order to get better curative effect and decrease the complications. Methods To retrospectively study 29 cases, （ 16 males and 13 females）. Their ages ranged from 18 to 57, median 45 years. All patients accepted operation synthesizing postoperative chemotherapy or radiotherapy. Surgical approaches： transoral approach; trans cervical approach; trans cervical combining mandibular swing approach; para- mandibular approach; maxillary swing approach; combined maxilleetomy and parapharyngeal space tumoreetomy. Results Pathological type： benign lesion 21 cases, malignant tumor 8 cases. After 5 years follow -up , all benign lesions have no recurrence. There was one case of osteosarcoma, recurred in 2 months after operation; one case of maxillary sinus cancer recurred in two years after operation; one case of mucoepidermoid carcinoma situa lateral pharyngeal wall recurred in 6 years after primary operation, and recurred in 2 years after secondary operation; one case of submandibulargland adenocystic carcinoma recurred and combined lung metastasis in 4 years after primary operation, give up treatment after recurrence and metastasis ; 2 cases of malignant lymphoma have no recurred till 5 years after chemotherapy. All patients received operation have no complications. Some patients got temple neurofunctional disorder, but they all recovered in half a year. Conclusion Transoral approach is only suitable for resecting small lesion just below the pharyngeal mucosa, trans cervical approach is suitable for excising mixed tumor, schwannoma and carotid body tumor situa parapharyngeal space, trans cervical combining mandibular swing approach is suitable for ectomizing tumor situa deep lobe of parotid and elevatus neurilemmoma, para -mandibular approach is suitable for block resection of malignant tumor and ascending ramus, maxillary swing approach or combined maxillectomy and parapharyngeal space tumorectomy is suitable for excising late stage malignant tumor or bases of skull tumor invading in parapharyngeal space.