内镜辅助在经颈和颈-腮腺径路切除咽旁间隙肿瘤中的应用

Endoscopy-assisted surgery for parapharyngeal space tumors using the transcervical and transcervical-parotid approaches

目的 探讨内镜在传统经颈和颈-腮腺径路切除咽旁间隙肿瘤中的潜在优势。方法 回顾分析2017年1月—2018年12月就诊于我院并接受经颈和经颈-腮腺径路咽旁间隙肿瘤切除术的87例患者的临床资料。根据术中有无应用内镜分为传统手术组和内镜辅助治疗组。传统手术组共纳入37例,28例采用颈侧径路,9例采用颈-腮腺径路。内镜辅助治疗组共纳入50例,40例采用颈侧径路,10例采用颈-腮腺径路。比较2组患者的临床特征和疗效差异。结果 2组患者术后病理均以良性多见,其中传统手术组35例(94.6%)为良性,内镜辅助治疗组45例(90.0%)为良性。2组患者在手术时间、术中出血量、住院时间、肿瘤全切率和复发率等方面差异均无统计学意义。内镜治疗组中有14例(28%)肿瘤近颅底,而传统手术组仅2例(5.4%),差异具有统计学意义(P<0.01)。结论 在传统手术径路中应用内镜,可以最大限度减少肿瘤破裂、神经损伤和出血等并发症,尤其是对于高位咽旁间隙肿瘤,有助于减小手术创伤,具有较好的美容和神经功能保留等潜在优势。

Objective To explore the potential advantages of endoscopy in traditional transcervical and transcervical-parotid approaches for resecting of parapharyngeal space(PPS)tumors.Methods Clinical data of 87 patients with PPS tumors treated at Eye&ENT Hospital,Fudan University from January 2017 to December 2018 were analyzed retrospectively.The patients were divided into the traditional group and the endoscopy-assisted group.The traditional group consisted of 37 cases,with 28 receiving a transcervical approach and 9 undergoing a transcervical-parotid approach.The endoscopy-assisted group included 50 patients,with 40 undergoing a transcervical approach and 10 receiving a transcervical-parotid approach.Clinical characteristics and postoperative effects were compared between the two groups.Results Postoperative pathology revealed that benign tumors accounted for the majority in both groups,with 35 cases(94.6%)in the traditional group and 45 cases(90.0%)in the endoscopy-assisted group.In terms of operation time,intraoperative blood loss,hospital stays,total tumor resection rate,or recurrence rate,there were no significant differences between the two groups.However,there was a statistically significant difference in the presence of tumors attending to the skull base:14 cases(28%)in the endoscopy-assisted group compared to just 2 cases(5.4%)in the traditional group(P<0.01).Conclusions Endoscopy-assisted surgery is useful for locating and protecting critical cranial nerves and blood vessels during surgery,especially for upper PPS tumors.It helps to reduce surgical trauma while offering additional benefits such as improved cosmetic effects and preservation of neurological function.