咽旁间隙肿瘤手术进路探讨

Study on operative approach of parapharyngeal space tumor.

目的 颈外进路切除咽旁间隙肿瘤创伤大 ,并发症多 ,面部或颈部留有疤痕。为了克服上述缺点 ,采用软腭进路切除咽旁间隙肿瘤。方法 患者仰卧 ,头向后伸 ,肩下垫小枕 ,戴维氏开口器撑开口腔。斜行切开软腭粘膜及粘膜下层 ,用血管钳钝性分离肌层达肿瘤包膜 ,沿包膜外用手指分离 ,待瘤体游离后完整摘除。结果 经软腭进路切除咽旁间隙肿瘤 3例 ,均取得了满意的效果。随访 6个月～ 5年无肿瘤复发。结论 经软腭进路切除位置较高达颅底、向鼻咽、口咽腔内隆起的咽旁前间隙良性肿瘤 ,手术经路短 ,最接近肿瘤 ,创伤小 ,损伤血管和神经机会小 ,手术时间短 ,可避免面部或颈部手术疤痕 ,操作简便 ,安全可行。

Objective Parapharyngeal space tumors present a formidable challenge to the Otolaryngol-Head Neck surgeon becuse of both the complex anatomic relationships and operative approaches.Methods Three patients with parapharyngeal mixed tumor excised via a transpalatal peroral technique are presented.Results The transpalatal approach was the appropriate choice in the patients with parapharyngeal mixed tumor. The anatomy of parapharyngeal space, pathological features of the tumors, surgical technique and operative approaches were discussed.Conclusion This method is a good choice for patients with parapharyngeal mixed tumor.