颞下窝-翼腭窝-咽旁间隙肿瘤手术进路探讨

Investigation of the surgical approach for resecting infratemporal fossa pterygomaxillary fossa-parapharyngeal space tumor

目的：探讨如何选择最佳手术进路切除颞下窝-翼腭窝-咽旁间隙肿瘤，以提高疗效，减少并发症和后遗症。方法：回顾性分析66例颞下窝、翼腭窝、咽旁间隙肿瘤患者，包括组织学诊断、影像学检查及手术人路。结果：50例良性肿瘤患者术后随访2～5年，均无复发；16例恶性肿瘤患者，术后随访2～5年，生存期不足1年4例，2～4年8例，5年及以上4例。结论：扩大上颌骨切除术适于上颌窦原发恶性肿瘤侵及翼腭窝、颞下窝和（或）咽旁间隙的患者；面正中揭翻术适于鼻腔、鼻窦、鼻咽及翼腭窝良性肿瘤及局限的恶性肿瘤患者；颈侧高位切开下颌骨外旋人路术适于咽旁间隙肿瘤累及翼腭窝和（或）颞下窝的患者；颈颌径路-下颌骨截骨术适于咽旁间隙-颞下窝良、恶件肿瘤侵犯侧颅底及翼腭窝的患者。

Objective： To investigate the otimal surgical approach for resecting infratemporal fossa-pterygo-maxillary fossa-parapharyngeal space tumor. The aim of this study is to enhance therapeutic effect and reduce complications and sequelaes. Method：Sixty-six patients with infratemporal fossa-pterygomaxillary fossa-parapharyngeal space tumor were analyzed retrospectively from 1998-2004, including complains, symptoms, physical signs; histodiagnosises, image examinations and surgical approachs. Result： No recurrence was found in fifty benign tumor cases after 2 to 5 years, while in 16 cases with malignant tumor, four patients died in one year, 8 cases died in 2 to 4 years, and only 4 patients＇ survival time exceeded 4 years. Conclusion： Extended maxillectomy is suitable for resecting primary carcinoma of maxillary sinus invading pterygomaxillary fossa, infratemporal fossa and/or parapharyngeal space tumor, also midface degloving approach is suitable for nasal primary cavity, nasal sinuses, nasopharynx and/or pterygomaxillary fossa tumor and localized malignant tumor. Trans-cervical combining mandibular split swing approach is suitable for parapharyngeal space tumor invading terygomaxillary fossa and/or infratemporal fossa tumor. Ttrans-cervical jaw combining mandibu-latomy is suitable for resecting parapharyngeal space, infratemporal fossa tumor for invading lateral skull base and pterygomaxillary fossa tumor.