咽旁间隙肿瘤45例诊断与治疗的临床分析

Diagnosis and Treatment of 45 Cases of Parapharyngeal Space Neoplasm

目的探讨咽旁间隙肿瘤的诊断和治疗。方法回顾性分析研究45例咽旁间隙肿瘤的临床表现、病理类型及诊治方法。结果45例咽旁间隙肿瘤肿良性36例(占80%)、恶性9例(占20%),神经源性良性肿瘤(16例)及涎腺混合瘤(11例)是最常见的肿瘤。临床表现为颈部或咽侧的肿块,可伴有吞咽不适、咽痛、头面麻木、听力下降、颈交感神经麻痹综合征(Horner syndrome)等症状。CT或MRI能显示肿瘤大小、形态、位置、与周围结构的关系等。本组肿瘤均经颈外侧切口入路手术切除。恶性肿瘤术后加用了放、化疗。随访1～10年,良性肿瘤无复发,恶性肿瘤3年生存率44%,5年生存率33%。结论CT、MRI对咽旁间隙肿瘤的诊断及指导手术有重要意义。颈外侧切口径路切除咽旁间隙肿瘤简易、安全、有效。

Objective To investigate the diagnosis and treatment of primary parapharyngeal space neoplasm. Methods 45 cases of primary parapharyngeal space neoplasm were included in the study and the clinical manifestation, pathological types, diagnosis and treatment were analyzed retrospectively. Results In all 45 cases, 36 cases （ 80% ） were benign and 9 cases （ 20% ） were malignant. The most common benign tumor was the salivary mixed tumor（ 11 cases） and neurogenic tumors （ 16 cases）. Their common symptom was tumor in the neck or pharyngeal portion, accompanying disorders of swallowing, pharyngodynia, acouesthesia degression and Homer syndrome, etc. CT or MRI provides the useful information such as sizes, shapes and extents of tumors, and the relationship between the tumor and vessels. All tumors were resected completely by the cervical lateral operative approach. The postoperative radiotherapy and chemotherapy was applied to the patients with malignant tumor. The following-up was carried out from 1 to 10 years, and the data indicated that the patients with benign tumor did not recur, the 3 and 5-year survival rates for the patients with malignant tumor were 44% and 33%. Conclusion CT or MRI are essentially useful for diagnosis and preoperative plan of primary parapharyngeal space neoplasm. It is facility, safety and effective to resect primary parapharyngeal space neoplasm by the cervical lateral operative approach.