72例咽旁间隙肿瘤患者的诊疗分析

Analysis and surgical treatment of 72 cases of parapharyngeal space tumors

目的:研究咽旁间隙肿瘤的临床诊断和外科治疗方法。方法:回顾性分析北京大学第一医院耳鼻咽喉头颈外科1994-03-2017-06期间收治的72例咽旁间隙肿瘤患者的临床资料,总结分析其临床表现、术前影像学评估、术后病理类型、手术径路选择、术后并发症及预后。结果:72例咽旁间隙肿瘤中良性62例,恶性10例。临床多表现为上颈部无痛性肿物或口咽侧壁隆起并伴有不同程度的吞咽、呼吸或语言功能障碍。CT或MRI能清楚显示肿块的大小、形态、位置、与周围结构的关系及继发改变。术后病理诊断涎腺来源肿瘤24例(33.3%),神经源性肿瘤30例(41.7%);手术并发症发生13例(18.1%)。颈侧径路55例(76.4%),颈腮径路9例(12.5%),经口径路6例(8.3%),侧颅底径路2例(2.8%)。完整切除肿瘤69例,姑息性切除3例。结论:咽旁间隙肿瘤周围解剖结构复杂,病理类型多样,手术切除是主要的治疗方法,但应根据肿瘤病理类型、大小及周围结构关系决定手术方式,对于神经源性肿瘤,手术并发症较多,术前应与患者充分沟通手术风险。

Objective：To summarize and analyze the clinical features,diagnosis methods,surgical approaches and treatment outcomes of patients with parapharygeal space tumors.Method：A retrospective review of 72 cases with parapharygeal space tumors treated from March 1994 to June 2017 was performed.The data on presentation,surgical approach,histological diagnosis and postoperative complications were reviewed.Result：The postoperative pathological diagnosis included 62 benign tumors and 10 malignant tumors.The most frequent symptom was a cervical mass or an intraoral swelling.All patients underwent preoperative enhanced CT scan or MRI,which would be helpful to evaluate the tumor sizes,locations and possible sources,and to make operation scheme.The postoperative pathology included 24 salivary gland lesions and 30 neurogenic lesions.The postoperative complications happened in 13 patients.The surgical approaches included trans-cervical approach in 55 cases,cervical-parotid approach in 9 cases,trans-oral approach in 6 cases,and trans skull base approach in 2 case.Conclusion：A parapharygeal space tumor is an uncommon tumor and requires careful preoperative assessment.Surgery is the first choice for parapharygeal space tumors.These patients should be counseled appropriately about the potential for permanent cranial nerve deficits.