经口径路与经颈部径路切除咽旁间隙肿瘤的对比分析

Trans-oral approach and trans-cervical approach in resection of parapharyngeal space tumors:a comparative analysis

目的探讨咽旁间隙良性肿瘤的手术方式。方法对郑州大学第一附属医院耳鼻喉医院2013年2月至2018年2月收治的48例咽旁间隙良性肿瘤患者的临床资料进行回顾性分析,所有患者术前均接受影像学检查,其中经颈部径路切除咽旁间隙肿瘤32例,经口径路切除咽旁间隙肿瘤16例,比较两种手术方式的治疗效果。结果病理结果提示:神经鞘瘤20例(41.7%),多形性腺瘤17例(35.4%),神经纤维瘤4例(8.3%),血管瘤4例(8.3%),囊肿3例(6.3%)。住院期间并发症:经颈部径路手术者发生并发症6例,经口径路手术者2例。术后随访10~62个月,经口径路手术者复发2例,经颈部径路手术者复发3例,均再次手术后治愈。通过统计学分析显示,经口径路与经颈部径路手术在患者性别、年龄、住院天数、住院期间并发症、术后是否复发方面比较差异未见统计学意义(P>0.05),在手术时长、术中出血量方面比较差异有统计学意义(P<0.05)。结论经口径路对于位于咽旁间隙前半部的肿瘤是一种较好的手术方式,而位于咽旁间隙后半部的神经源性肿瘤,建议采用经颈部径路。

Objective To investigate the operative methods for benign tumors in parapharyngeal space.Methods The clinical data from 48 patients with benign tumors in parapharyngeal space admitted to Otolaryngology Hospital, the First Affiliated Hospital of Zhengzhou University from February 2013 to February 2018 were retrospectively analyzed. All patients underwent imaging examination before surgery. Thirty-two cases of parapharyngeal space tumors were resected by trans-cervical approach and 16 cases by trans-oral approach. The therapeutic effects of the two methods were compared.Results Pathological results showed 20 cases (41.7%) of schwannoma, 17 cases (35.4%) of pleomorphic adenoma, 4 cases (8.3%) of neurofibroma, 4 cases (8.3%) of hemangioma and 3 cases (6.3%) of cyst. During hospitalization, 6 cases who were given trans-cervical approach surgery had complications, and 2 cases treated by trans-oral approach surgery had complications. Postoperative follow-up ranged from 10 to 62 months. Two cases treated by trans-oral approach recurred, and 3 cases treated by trans-cervical approach recurred. All of the 5 patients were cured by performing operation again. Statistical analysis showed that there was no significant difference in gender, age, length of hospital stay, incidence of complications during hospitalization or recurrence between the two surgery approaches (P>0.05);however, there was a significant difference in operation duration and intraoperative bleeding between the two approaches (P<0.05).Conclusions The trans-oral approach is a better surgical method for tumors located in the anterior half of parapharyngeal space, while trans-cervical approach is recommended to neurogenic tumors located in the posterior half of parapharyngeal space.