经口内镜翼下颌韧带旁内进路咽旁间隙肿瘤切除的技巧和风险控制

Surgical technique and risk control of tumor resection in parapharyngeal space via transoral endoscopic parapterygomandibular ligament internal approach

由于咽旁间隙位置深在,解剖结构复杂,探索改良的咽旁间隙肿瘤手术进路成为近年来头颈外科的热点之一。经口内镜进路具有创伤小、路径短的优点,逐渐广泛应用于咽旁间隙肿瘤的切除。然而,由于手术空间有限,肿瘤暴露困难,导致经口内镜进路手术难度大,风险控制十分关键。经口内镜翼下颌韧带旁内进路可以充分暴露咽旁间隙肿瘤的上、下极,避免损伤腭大、腭小神经和血管,同时对口腔和软腭黏膜以及腭帆张肌和腭帆提肌的功能有良好的保护作用,手术创伤小,术后并发症少。

Due to the deep location and complex anatomy of the parapharyngeal space,the exploration of improved surgical approach for tumors in the parapharyngeal space is one of the hotspots in the head and neck surgery in recent years.Transoral endoscopic approach has the advantages of small trauma and short path,which is gradually widely used in the resection of tumors in the parapharyngeal space.However,due to the limited operation space and the difficulty of tumor exposure,it is laborious to operate through transoral approach,and the risk control is rather critical.The transoral endoscopic parapterygomandibular ligament internal approach can fully expose the upper and lower poles of tumors in the parapharyngeal space,and avoid damage to the greater and lesser palatine nerve and blood vessels.This surgical approach has a satisfactory protective effect on the sensory function of oral and soft palate mucosa,as well as the tensor velum palatine muscle and levator velum palatine muscle with less surgical trauma and fewer postoperative complications.