咽旁间隙肿瘤43例临床分析

Analysis of clinical data of 43 cases of parapharyngeal space tumors

目的:掌握咽旁间隙解剖,分析咽旁间隙肿瘤病理类型、术前评估、手术径路选择及术后处理。方法:对我科2002-03-2011-01期间43例经手术治疗的咽旁间隙肿瘤患者的临床资料进行回顾性分析。全部患者术前行增强CT和MRI检查,2009年后的患者术前均行增强CT三维重建。所有患者均在全身麻醉下行手术治疗,行颈侧径路术者38例,颈侧腮腺入路者3例,经颈侧径路行下颌骨裂开术者2例,其中1例同时行气管切开术。全部患者术腔留置负压引流,无用药禁忌者给予糖皮质激素。结果:一次性肿瘤完整切除者42例。1例腮腺深叶多形性腺瘤患者术后3年复发,再次手术后治愈。结论:咽旁间隙位置深在,解剖复杂。该区域肿瘤发病率低,且以良性者居多。手术切除是首选的治疗方案,颈侧入路最为常用。CT和MRI检查是有效的术前检查,增强CT三维重建可以提供更为直观的空间构象。

Objective：To learn the anatomical structure of the parapharyngeal space and to analyze the pathological type,preoperative evaluation and choice of surgical approach of parapharyngeal space tumors.Method：To conduct a retrospective analysis of the clinical data of 43 patients who receive surgery in our department from March 2002 to January 2011.All patients undergo enhanced CT and MRI before surgery and enhanced CT reconstruction was also adopted in the cases after the year 2009.All 43 cases of surgeries were performed under general anesthesia.Of all the cases,the lateral neck path were chosen for 38 cases,lateral neck parotid path for 3 and lateral neck path combined with mandibular split operation for 2,1 of which tracheotomy was conducted.Suction drainage was placed in the surgical cavity of all cases.And patients without contraindications were treated with glucocorticoids.Result：In 42 of all 43cases,the tumor was removed completely during the first operation while tumor reoccurred after 3 years and was cured by reoperation in the other one case.Conclusion：Parapharyngeal space is deep and the anatomy structure is complicated.Cancer incidence rate is low and mostly benign in this regional.Surgical resection is the preferred treatment and lateral neck approach is most commonly used.CT and MRI is an effective preoperative examination and enhanced CT reconstruction can provide a more intuitive spatial conformation.