咽旁间隙肿瘤

Parapharyngeal space neoplasms

目的讨论临床罕见的咽旁间隙肿瘤。方法总结１９８６年～１９９７年７月收治的５９例患者的回顾性资料。结果原发性咽旁间隙肿瘤中，以神经源性肿瘤居多，约占６０％。高分辨ＣＴ及ＭＲＩ对临床诊断及手术径路的选择有重要作用。颈侧切开广泛应用于７５％的良性病变；应用下颌骨正中裂开切除２例局限于隙上部的良性肿瘤和１例侵及颅底的颈动脉体瘤；应用侧颅底入路切除１例起源于颈静脉孔生长至咽旁间隙的神经鞘瘤。结论认为经口径路仅用于较小的肿瘤切除；经颈腮腺径路主要用于侵入咽旁间隙的腮腺深叶肿瘤的切除；经颈下颌骨正中裂开径路是切除咽旁间隙特殊肿瘤安全有效的入路。

Objective To study parapharyngeal space (PPS) neoplasms which are rarely seen clinically. Methods A retrospective review was made of 59 patients with PPS neoplasm operated on from 1986 to July, 1997 in our institution. Results Neurogenic tumors were the most common neoplasms, which constitued about 60 percent in the primary parapharyngeal space neoplasms. High resolution computed tomography or magnetic resonance imaging was essential for diagnosis and presurgical planning. The transcervical approach was the preferred procedure for 75% benign parapharyngeal tumors. Middle mandibulotomy was used in 3 cases, including 2 small tumors confined to the superior aspect of the PPS and 1 carotid body tumor which extended to the skull base. Lateral skull base approach was utilized for 1 schwannoma originating in the jugular foramen with extension into the PPS. Conclusions We believe that transoral approach can be used for small tumors and transparotid approach may be especially indicated for removal of deep lobe parotid tumors with extension to the PPS. Middle mandibulotomy is a safe and efficacious approach for the removal of special PPS neoplasms.