经口内镜翼下颌皱襞内侧入路咽旁间隙良性肿瘤切除术

Transoral endoscopic resection of benign tumors in parapharyngeal space via medial pterygomandibular raphe approach

目的探讨经口内镜翼下颌皱襞内侧入路切除咽旁间隙良性肿瘤的手术方法,并评估其临床效果。方法回顾性分析2016年1月至2020年7月,于青岛大学附属医院耳鼻咽喉头颈外科接受经口内镜翼下颌皱襞内侧入路咽旁间隙良性肿瘤切除术的23例患者的临床资料,其中男14例,女9例,中位年龄43岁。肿瘤位于茎突前间隙者13例,位于茎突后间隙者10例。肿瘤体积最小为7.3 ml,最大为80.2 ml。分析所有病例术前的影像学特点,分析该径路在进行咽旁间隙肿瘤手术中的特点、风险,并探索可行的手术模式。结果所有患者均顺利完成手术,术中出血量20~50 ml、平均28.3 ml,手术时间40~110 min、平均75.4 min,切口长度2~4 cm、平均3.0 cm,术后疼痛评分2~4分、平均3.2分,术后住院天数4~9 d、平均6.7 d。术后病理诊断多形性腺瘤12例,神经鞘瘤10例,基底细胞腺瘤1例。术后随访6~60个月,未出现术腔感染、出血等并发症,肿瘤无复发。结论经口内镜翼下颌皱襞内侧入路咽旁间隙良性肿瘤切除术是一种安全、有效的治疗咽旁间隙肿瘤的微创术式。

Objective To explore the surgical methods and effects of transoral endoscopic resection of benign tumors in parapharyngeal space via medial pterygomandibular raphe approach.Methods The clinical data of 23 patients who underwent resection of benign tumors in parapharyngeal space by endoscopic medial pterygomandibular raphe approach from January 2016 to July 2020 in the Department of Otorhinolaryngology Head and Neck Surgery,the Affiliated Hospital of Qingdao University were analyzed retrospectively.There were 14 males and 9 females with a median age of 43 years.The tumors were located in the anterior space of the styloid process in 13 cases and in the posterior space in 10 cases.The smallest tumor volume was 7.3 ml and the largest was 80.2 ml.The preoperative imaging features,the characteristics and risks of this approach in the operation were analyzed,and the feasible mode of operation was explored.Results All patients completed the operation successfully.The intraoperative blood loss was 20 to 50 ml,with an average of 28.3 ml.The operation time was 40 to 110 min,with an average of 75.4 min.The incision length was 2 to 4 cm,with an average of 3.0 cm.The postoperative pain score was 2 to 4,with an average of 3.2.The postoperative hospital stay was 4 to 9 d,with an average of 6.7 d.Postoperative pathological diagnosis included pleomorphic adenoma(n=12),neurilemmoma(n=10)and basal cell adenoma(n=1).The patients were followed up for 6 to 60 months.There was no postoperative complication such as infection or serious bleeding,and there was no tumor recurrence after operation.Conclusion Endoscopic resection of benign tumor in parapharyngeal space via medial pterygomandibular raphe approach is a safe,effective,and minimally invasive surgical method for the treatment of tumors in parapharyngeal space.