高位咽旁间隙良性肿瘤的手术治疗

The surgical management of upper parapharyngeal regions

目的:探讨高位咽旁间隙良性肿瘤的手术方法选择。方法:对9例涉及颅底、颅内的高位咽旁间隙良性肿瘤完整的临床资料进行回顾性分析。其中神经鞘瘤6例,多形性腺瘤2例,血管瘤1例。患者均行高分辨CT和MRI检查,部分病例行DSA检查,4例达鼻咽顶部,3例涉及颅底骨质,2例侵入颅内。9例均单纯手术治疗,高清鼻内镜及导航系统辅助,部分患者使用低温等离子刀,手术入路:颈侧入路3例(辅助下颌角裂开2例),口内入路3例,经鼻入路2例,颈腮腺入路1例。结果:8例患者完全切除肿瘤,1例部分肿瘤残留;出血500ml以上2例,1例出现伸舌偏斜及脑脊液漏;无死亡病例;无伤口感染;所有患者均密切随访,无肿瘤复发。结论:高位咽旁间隙良性肿瘤位置深在,常涉及颅底、颅内,与颅底重要神经血管及脑膜关系紧密,应根据患者的不同情况及影像学资料选用适宜的手术入路,彻底切除肿瘤并保留或重建重要的血管神经功能,避免发生并发症是手术的要点。

Objective:To find proper the surgical approval and evaluate clinical efficacy to treat the tumor of upper parapharyngeal space involving the base of skull and intracranial skull.Method:The data of 9cases from June 2013and June 2018were analyzed retrospectively including schwannoma in 6cases,pleomorphic adenoma in 2cases and hemangioma in 1case.All cases received preoperative high resolution CT and MRI,some cases also did the DSA examination.Tumor invaded top of nasopharyngeal in 4cases,the base of skull in 3cases,and intraskull in 2cases.9cases were treated with surgery alone.Surgical approach:transcervical approach (n=1),transcervical approach and mandibular fracture surgery (n =2),transoral approach (n =3),transnasal transpterygoid approach(n=2),transparotid gland approach(n=1).Result:Tumors in 8cases were completely removed,and 1 case was performed by partial excision.Hemorrhage(>500ml)occurred in 2cases,tongue deflection and cerebrospinal fluid leakage occurred in 1case.No death,tumor recurrence and wound infection was found.Conclusion.. The position of benign upper parapharyngeal space tumors is deep and tumor often invade in the base of the skull and brain tissue.It is close to the important nerve,vessels of the skull base and meninges.The appropriate surgical approach should be selected according to the individual situation.The main point of the operation is complete the tumor resection with preserving or reconstructing the important function of the blood vessel and nerve.