颈动脉内侧咽旁间隙肿瘤手术治疗

Surgical experience for parapharyngeal space tumors located in the medial part of the carotid artery

目的探讨位于颈动脉内侧的咽旁间隙肿瘤手术的有效方法。方法对2003年2月～2011年10月位于颈动脉内侧的咽旁间隙肿瘤病例的临床资料和手术过程进行回顾性分析。12例肿瘤皆行颈侧切开入路。若瘤体主要部分位于颈动脉分叉处以上需要切断颈外动脉以暴露瘤体。若侵及颅底的肿瘤太大,无法完整摘除,可先于包膜内部分分次切除肿瘤;若侵及颅底的肿瘤剥离有困难,也可借助内镜技术。结果 12例患者均手术成功,且术后均无并发症。术后病理分别为神经鞘膜瘤8例(67%),副神经节瘤、脂肪瘤、腮腺混合瘤、腺样囊性癌各1例(8%)。结论位于颈动脉内侧的咽旁间隙肿瘤,根据瘤体的部位和性质,采用不同的方法可安全完整切除。

OBJECTIVE To investigate the effective surgical methods for parapharyngeal space tumors located in the medial part of the carotid artery. METHODS Clinical data and surgical processes of 12 cases with parapharyngeal space tumors located in the medial part of the carotid artery were summarized retrospectively. All tumors were removed through transcervical approach. For the tumor was situated upon the carotid bifuracation, the external carotid artery was cut in order to provide excellent exposure of the tumors. If the tumor was too big and can not be removed in bloc, the tumor can be removed piece by piece under the capsular membrane of the tumor. Also, endoscopic techniques would help a lot for the tumors involving the skull base. RESULTS All of the tumors of the 12 cases were removed completely without any complications, and the pathological report showed schwannoma in 8 cases, paraganglioma, lipoma, parotid mixed tumor and adenoid cystic carcinoma in one case respectively. CONCLUSION Based on the extent, location and the pathological type of the tumor in parapharyngeal space, proper method can be adopted to make the tumors exposed clearly and remove the tumors completely.