等离子及高清内镜系统辅助下经口入路切除咽旁间隙肿瘤23例疗效分析

Efficacy analysis of 23 cases of parapharyngeal space tumors removed by oral approach assisted by plasma and high-definition endoscopic system

目的:探讨等离子及高清内镜系统辅助下经口入路咽旁间隙肿瘤切除术中适应证的选择、疗效及应用体会。方法:回顾性分析2013年1月-2023年6月于蚌埠医科大学第一附属医院耳鼻咽喉头颈外科收治的23例在等离子及高清内镜系统辅助下经口入路咽旁间隙肿瘤切除患者的临床资料。所有患者术前均行高分辨CT和MRI检查,部分患者行CTA或DSA检查。术中采用高清鼻内镜摄录系统辅助,部分患者使用低温等离子刀。术后密切随访,随访3~115个月,中位随访时间45个月。结果:本组无死亡患者,所有患者均完整切除肿瘤,肿瘤最大直径为(5.20±1.00)cm,手术时间为(128.70±46.67)min,平均出血量为(80.87±32.74)mL,1例血管平滑肌肿瘤术中出血较多,术后辅助气管切开,1例巨大神经鞘瘤术后滋养血管出血予以探查止血+颈外动脉结扎,其他患者出血均在120 mL以下。术后病理均为良性肿瘤,多形性腺瘤11例,神经鞘瘤4例,基地细胞腺瘤2例,表皮样囊肿1例,淋巴管囊肿伴感染1例,血管平滑肌瘤1例,孤立性纤维瘤1例,涎腺囊肿1例,腱鞘巨细胞瘤1例。所有患者均获随访,1例起源于迷走神经鞘瘤患者囊内取瘤术后出现2个月声带麻痹,复发1例(神经鞘瘤颅底复发)。结论:等离子及高清内镜系统辅助下经口入路适用于部分选择性咽旁间隙良性肿瘤的切除,具有创伤小、恢复快的优势。当肿瘤富血、怀疑恶性、肿瘤顶部深入颅底神经孔道并位于颈内动脉外侧以及直径大于6.0 cm且考虑多形性腺瘤时均建议行外开放或辅助颈部小切口入路。

Objective:To explore the selection,efficacy and application of indications for parapharyngeal space tumor resection assisted by plasma and HD endoscopic system through oral approach.Methods: The clinical data of 23 patients with parapharyngeal space tumor resection assisted by plasma and HD endoscopic system were retrospectively analyzed in Department of Otolaryngology Head and Neck Surgery,the First Affiliated Hospital of Bengbu Medical University from January 2013 to June 2023.All cases were examined by high-resolution CT and MRI before operation,and some cases were examined by CTA or DSA.During the operation,the high definition nasal endoscopic recording system was assisted,and low temperature plasma knife was used in some cases.The follow-up time was from 3 to 115 months,and the median follow-up time was 45 months.Results: There were no deaths in this group.All patients had complete tumor resection.The maximum tumor diameter was as follows:(5.20±1.00)cm,the operation time was(128.70±46.67)min,and the average blood loss was(80.87±32.74)mL.One case of vascular smooth muscle tumor had more bleeding during the operation and was assisted by tracheotomy after operation.One case of nourishing vascular bleeding after operation of giant Schwannoma was investigated and hemostasis+external carotid artery ligation.Bleeding in the remaining cases was below 120 mL.Postoperative pathologies were all benign tumors,including 11 pleomorphic adenoma,4 schwannoma,2 base cell adenoma,1 epidermoid cyst,1 lymphatic cyst with infection,1 angiomyoma,1 solitary fibroma,1 salivary gland cyst,and 1 tendon giant cell tumor.All patients were followed up.One patient originating from vagal schwannoma had 2-month vocal cord paralysis and 1 recurrence(recurrence of the skull base of schwannoma).Conclusion: Oral approach assisted by plasma and high-definition endoscopic system is suitable for partial selective resection of benign tumors in parapharyngeal space,which has the advantages of less trauma and rapid recovery.When the tumor is blood-rich,suspected to be malignant,the top of the tumor is deep into the cranial base nerve canal,located outside the internal carotid artery,and larger than 6.0 cm considering pleomorphic adenoma,it is recommended to conduct an external open or auxiliary cervical small incision approach.