咽旁间隙良性肿瘤的影像学特征及经口手术进路分析

Imageology features and transoral approach of benign parapharyngeal space tumors

目的:分析咽旁间隙良性肿瘤的影像学特征,总结咽旁间隙良性肿瘤手术入路的选择,尤其是经口进路切除咽旁间隙良性肿瘤的方法。方法:回顾性分析1997-2006年收治的48例咽旁间隙良性肿瘤患者的临床资料,术前全部行CT增强扫描,部分行MRI扫描。全部手术治疗,经口进路16例(33.3%),单纯颈侧进路19例(39.6%),颈侧腮腺进路13例(27.1%)。结果:CT和MRI能很好地显示肿瘤的部位、形状、大小、范围及可能的病理性质。术后3年内复发2例。经口进路术后发生霍纳氏征1例,术腔血肿形成1例。颈侧进路发生暂时性面瘫5例,副神经麻痹1例。结论:CT和MRI扫描能区分咽旁肿瘤位于茎突前或茎突后间隙以及和邻近组织的关系,手术入路应根据肿瘤的大小、位置和重要血管之间的关系来选择。部分咽旁间隙良性肿瘤经口进路切除安全可行,与颈侧进路比较并不增加手术的危险性和术后复发率,符合微创美观的原则。

Objective：To analyze the imageology features of benign parapharyngeal space（PPS）tumors,and also to summarize our experience in removing PPS benign tumors through transoral approach.Method：A retrospective review was conducted to 48patients with benign tumors in PPS during a 10-year period.CT were performed in all patients,and only a few required MRI.Transoral approach（33.3%） and transcervical（39.6%） were the most commonly performed surgical procedures followed by the transcervical-transparotid approach（27.1%）.Result：CT scan and MRI often provided complementary information to help the surgeons delineate the size,precise location and likely cause of these tumors.After a follow-up of three years,only 2 of 48 patients had disease recurrence.The transoral approach described herein safely allowed for en bloc resection of most benign neoplasms.No significant complications attributed to the approach itself.Conclusion：CT or MRI scan can distinguish prestyloid from poststyloid lesions,and to assess the extension of the tumor as well as its relationship with adjacent structures.The transoral approach safely provides access to some benign PPS tumors with a low rate of complications and recurrence as well as traditional transcervical approaches.