涉及颅底咽旁间隙肿瘤的治疗

The surgical management of parapharyngeal space neoplasms with skull base involved

目的:探讨涉及颅底咽旁间隙肿瘤处理的有效方法。方法:对2000年3月～2005年7月36例涉及颅底咽旁间隙肿瘤患者资料进行回顾性分析。采用的手术入路分别是:经颈侧切开入路15例,经颈-腮腺入路10例,下颌骨外旋入路4例,上颌外旋入路5例,眶颧入路2例。结果:36例肿瘤中,5例为恶性肿瘤,其余皆为良性肿瘤。31例良性肿瘤皆完整切除。5例恶性肿瘤中有2例为鼻咽黏膜下型鳞状细胞癌颅底咽旁间隙转移,经颈侧切开探查病理确诊后放射治疗,1例随诊3年无复发;1例随诊5年,复发带瘤生存;1例侵犯颅底的恶性神经纤维瘤术后3年复发,放弃治疗死亡;1例侵犯颅底的恶性神经鞘膜瘤术后已随诊3年余,健在;1例腮腺深叶黏液表皮样癌,已随诊2年余,健在。36例中,术后声嘶者3例伴呛咳1例,4例发生Horner综合征;2例发生舌偏斜,3个月后好转。结论:不同的涉及颅底咽旁间隙肿瘤有不同的临床特点,应根据各自的临床特点选择适当的处理方法。

Objective：To describe the most appropriate treatment to parapharyngeal space tumors with skull base involved. Method：From March .2000 to July 2004, a retrospective review of 36 patients with tumors of parapharyngeal space with skull base involved and treated surgically procedure was performed. Analyze the clinical characteristics of different tumors of parapharyngeal space with skull base involved. To the various tumors in this series, several surgical approaches were selected： the transcervlcal （n= 15） and transcervical-transparotid approaches （n= 10） were the most commonly performed surgical procedures followed by the transmaxillar swing approach （n=5）, the transmandible swing approach （n=4）, andtransorbitozygomatic-middle fossa approach （n=2）,Result： In the 36 cases, 5 cases were malignant carcinoma and the others （n=31） were benign. All benign tumors in 31 cases had complete resection with no recurrence. Of the 5 patients with malignant tumors, 2 had SCC （squamous cell carcinoma） of nasopharynx infra-mucous membrane with metastasis in the parapharygeal space and skull base lesions, after the pathologic identification by the surgical management of transcervical approach, both had undergone post-operative radiotherapy, 1 had disease free with a 3-year follow-up; the other after a follow-up of 5 years, was still alive with disease. Of the other 3 patients, 1 patient with the skull base lesions of malignant neurofibroma had recurrence after a 3-year follow-up, died without therapy at the end; 1 with malignant schwannomas and skull base lesions was alive with no evidence of disease after a follow-up of 2 years; 1 patient with mucoepidermoid carcinoma in deep lobe of parotid gland had operation done 3 months ago, was still under followed. In the 36 cases, post-operative hoarseness occurred in 3 cases; Horner＇s syndrome occurred in 4 cases; 2 patients had glossal deviation, and it had recovered 3 months later.Conclusion： Different tumors of parapharyngeal space with skull base involved have different clinical characteristics. Therefore, we should depend on its characteristics to choose the most appropriate treatment.