咽旁间隙肿瘤的诊断及手术入路选择

Diagnosis and surgical approach of parapharyngeal space neoplasms

目的:探讨咽旁间隙肿瘤的诊断及手术入路的合理选择。方法:对45例咽旁间隙肿瘤患者的资料进行回顾性分析。患者均行CT及颈部彩超检查,部分患者行MRI或DSA检查。采用的手术入路分别为:颈侧切开入路35例,腮腺入路5例,颈颌入路2例,颞骨加腮腺入路3例。结果:45例患者中良、恶性肿瘤分别为37例(82.22%)和8例(17.78%),其中以神经源性及涎腺来源最为常见。应用CT、MRI和DSA明确肿瘤的位置、大小、形态、密度、强化程度及肿瘤与茎突和颈动脉的关系,作出术前诊断,其与术后病理诊断的符合率为80%(组织来源符合率)。37例良性肿瘤完整切除,1例淋巴管瘤术后1年复发,再次手术后无复发。8例恶性肿瘤中,2例为恶性混合瘤,1例随诊4年无复发,1例随诊3年,带瘤生存;2例滑膜肉瘤,1例随诊3年无复发,1例随诊2年无复发;1例鼻咽癌咽旁间隙转移,术后给予根治性放疗,随诊5年无复发;1例脊索瘤随诊3年,复发带瘤生存;1例低分化鳞状细胞癌随诊4年,死于肺转移;1例滤泡树突状细胞肉瘤随诊2年无复发;结论:CT、MRI和DSA对咽旁间隙肿瘤的诊断与鉴别诊断具有重要意义。颈侧切开入路简便、安全、创伤小,是咽旁间隙肿瘤手术的最佳入路。

Objective：To explore the diagnosis and reasonable surgical approach for parapharyngeal space neoplasms.Method：From July 2004 to July 2009,a retrospective review of 45 patients with neoplasms of parapharyngeal space was performed.Fourty-five cases were examined by CT,some of them were examined by MRI or DSA.Several surgical approaches were selected.The transcervical approach was used in 35 cases,the transparotid approach was used in 5 cases,the transmandible approach was used in 2 cases,and the transparotid and temporal approach was used in 3 cases.Result：Among 45 patients,37 cases（82.22%） were benign and 8 cases（17.78%） were malignant.Neurogenic neoplasms and salivary glands neoplasms were the most common tumors.Using CT,MRI or DSA could obtain useful information about the location,size,shape,density and degree of enhancement of the parapharyngeal space neoplasms,acquire their relationship with styloid and carotid,and make preoperative diagnosis.The diagnostic coincidence rate between preoperative diagnosis and pathological diagnosis was 80%（origin of tissue）.All benign tumors were completely resected.A lymphangiomas had recurrence after 1 year,and the second operation had no recurrence.In the 45 cases,8 cases were malignant tumors.Of 2 patients with malignant mixed tumors,1 survived disease free after a follow-up of 4 years,and another was still alive with disease after a follow-up of 3 years;Of 2 patients with synovial sarcomas,1 survived disease free for a follow-up of 3 years,the other one survived disease free after a follow-up of 2 years;1 patient of nasopharyngeal carcinoma with metastasis in the parapharyngeal space had post-operative radical radiotherapy and survived disease free after a follow-up of 5 years.One patient with chordoma was still alive with disease after a follow-up of 3 years;1 patient with poorly differentiated squamous cell carcinoma,died of pulmonary metastasis after a 4 year follow-up;1 case with follicular dendritic cell sarcoma survived disease free after a follow-up of 2 years.Conclusion：CT,MRI and DSA are essential for the diagnosis and differentiation of parapharyngeal space neoplasm.The transcervical approach is a simple,safe and minimal invasive procedure for resecting parapharyngeal space neoplasms.It is the best approach for treatment of parapharyngeal space neoplasms.