颈部径路咽周-颅底神经源性肿瘤外科治疗探讨

Surgical treatment of neurogenic tumors around parapharyngeal space and skull base via cervical approaches

目的:探讨颈部径路咽周-颅底神经源性肿瘤的手术入路及方式。方法:将1997-2013年广东省第二人民医院采用颈颌入路和腮颈颌入路手术切除咽周-颅底神经源性肿瘤患者25例作为研究对象,对其手术入路及施术要点进行总结分析。结果:均顺利施行全切,术后病理检查显示神经鞘膜瘤23例、神经纤维瘤2例。术后随访6个月至5年,所有患者未见肿瘤复发。术中出现舌咽、迷走神经损伤4例,其中1例8个月后恢复;霍纳征1例,术后6个月恢复;舌下神经损伤2例,可能为永久性损害;腮腺漏2例。无手术死亡。结论:颈颌入路与腮颈颌入路是该区较好的手术途径,下颌骨截断对涉及颅底难以切除的肿瘤提供了较宽阔的视野。

Objective：To investigate the surgical approach and option for neurogenic tumors around parapharyngeal space and skull base. Methods：Included in this study were 25 cases of neurogenic tumors around parapharyngeal space and skull base surgically treated via mandibular-cervical or parotid-cervical approach at the Second People′s Hospital of Guangdong Province between 1997 and 2013. We summarized and analyzed the surgical approaches and important tips of the treatments. Results： All tumors were successfully removed. Postoperative pathological studies revealed neurilemmoma in 23 cases and neurofibroma in 2 cases. The patients were followed up for 6 months to 5 years,and none of them was found to have tumor recurrence. Glossopharyngeal or vagus nerve injury occurred during operation in 4 patients,including one patient who recovered 8 months later;Horner syndrome was found in one patient who recovered 6 months later; hypoglossal nerve injury occurred in 2 cases and appeared to be permanent;parotid gland fistula occurred in 2 cases. There was no death for surgery. Conclusion： Mandibular-cervical approach and parotid-cervical approach are better choice for surgery to the retropharyngeal space. Mandibulotomy can provide a wide surgical field for tumors involving the skull base.