改良颈-腮腺入路高位咽旁间隙肿瘤切除术探讨

Modified transcervical-transparotid approach for high-positional parapharyngeal space tumors

目的总结改良颈-腮腺入路切除高位咽旁间隙肿瘤的可靠性和安全性。方法回顾性分析经我科手术治疗的35例高位咽旁间隙肿瘤患者,术前均进行增强CT和MRI评估。其中24例采用单纯的颈-腮腺入路完整切除肿瘤,3例颅底受累者采取颈-腮腺入路联合颞枕侧颅底入路,2例混合瘤患者采用颈-腮腺入路联合下颌角部分切除,3例神经鞘瘤和1例淋巴血管瘤尝试采用颈-腮腺入路联合内镜辅助下手术,1例癌肉瘤和颅底受累及1例颈动脉体瘤术中改行联合下颌骨裂开入路。结果术后病理混合瘤13例,神经鞘瘤11例,副神经节瘤4例,颈动脉体瘤4例,淋巴血管瘤1例,脊索瘤1例和癌肉瘤1例。患者随访11个月～10年,无严重并发症,癌肉瘤患者术后13个月出现脑转移死亡。结论多数高位咽旁间隙良性肿瘤可以经传统颈-腮腺入路完整切除,改良的颈-腮腺入路可以得到清晰的术野暴露,完整切除高位咽旁间隙肿瘤,只有在恶性肿瘤或需要颈内动脉重建时才考虑联合下颌骨裂开术。

OBJECTIVE The purpose of this article is to describe the safety and reliability of the modified transcervical-transparotid approach for the high-positional PPS tumors.METHODS This study is a retrospective review of 35 patients diagnosed with PPS tumors.All patients had the preoperative contrast CT and MRI scans.24 cases were operated by the transcervical-transparotid approaches,3 cases were done by the transcervicaltransparotid approaches combined the lateral skull base approaches.2 larger PPS benign tumors were done by the trasncervial-transparotid approach combined with the partial resection of the angulus mandibulae.2 benign schwannomas and 1 lympatic angioma were done by the assisted endoscopic technique.One carcionsarcoma and one carotid body tumor with skull base involved were done by the transcervial-transparotid approach combined with the split of the mandible.RESULTS The histology results are as follows： pleomorphic adenomas of 14 cases,schwannomas of 11 cases,paragangliomaa of 5 cases,carotid body tumors of 3 cases,lymphatic hemangioma,chordoma and carcinosarcoma of 1 case,respectively.There no serious complication of most cases during the 11 months to 10 years follow-up,except the patient with carcinosarcoma died of brain metastasis 13months after surgery.No recurrence was found of the benign PPS tumors.CONCLUSION The transcervical-transparotid approach was good enough for most high-positional PPS turmors.We could get more exposure of the skull base and safely remove the whole tumor by the modified transcervical-transparotid approaches.