CAJ | 학술논문

目的总结原发性咽旁间隙肿瘤的临床特征、诊断方法、手术方法及疗效.方法回顾性分析解放军总医院2006年1月至2008年12月收治的40例原发性咽旁肿瘤患者的临床资料,其中男22例,女18例；年龄1 ～77岁,中位年龄42岁.CT扫描结合MRI检查有助于咽旁间隙肿瘤的诊断和手术方案的制定.手术方式包括:经口入路1例,经颈部入路22例,经腮腺-颈部入路8例,下颌升支纵行裂开入路1例,经颈部-下颌角部分切除入路4例,经腮腺进路2例,耳后颅颈联合入路2例.结果 40例患者均经手术切除,术后病理诊断良性肿瘤28例,恶性肿瘤12例,其中涎腺来源15例,神经来源12例,其余13例为其他组织来源.28例良性肿瘤中,23例经一次手术治愈,随访13～47个月无复发,中位数39个月.12例恶性肿瘤经随访3～50个月,中位数29个月,6例存活(随访时间24～ 50个月,中位数36个月),3例在术后6个月内死亡,3例失访.术后发生脑脊液漏1例,术腔感染2例,迷走神经损伤3例.结论手术切除是治疗咽旁间隙肿瘤的首选方法,绝大多数肿瘤可以经单纯颈侧入路切除；对于恶性肿瘤或较大的良性肿瘤应选择较宽阔的手术入路.咽旁间隙的良性肿瘤预后较好,而恶性肿瘤组织类型复杂多样,治疗效果差,预后不良.
목적 총결원발성인방간극종류적림상특정、진단방법、수술방법급료효.방법 회고성분석해방군총의원2006년1월지2008년12월수치적40례원발성인방종류환자적림상자료,기중남22례,녀18례；년령1 ～77세,중위년령42세.CT소묘결합MRI검사유조우인방간극종류적진단화수술방안적제정.수술방식포괄:경구입로1례,경경부입로22례,경시선-경부입로8례,하합승지종행렬개입로1례,경경부-하합각부분절제입로4례,경시선진로2례,이후로경연합입로2례.결과 40례환자균경수술절제,술후병리진단량성종류28례,악성종류12례,기중연선래원15례,신경래원12례,기여13례위기타조직래원.28례량성종류중,23례경일차수술치유,수방13～47개월무복발,중위수39개월.12례악성종류경수방3～50개월,중위수29개월,6례존활(수방시간24～ 50개월,중위수36개월),3례재술후6개월내사망,3례실방.술후발생뇌척액루1례,술강감염2례,미주신경손상3례.결론 수술절제시치료인방간극종류적수선방법,절대다수종류가이경단순경측입로절제；대우악성종류혹교대적량성종류응선택교관활적수술입로.인방간극적량성종류예후교호,이악성종류조직류형복잡다양,치료효과차,예후불량.
Objective To study the clinical characteristics,diagnosis and surgical managements of the parapharyngeal space tumors. Methods A retrospective study of 40 patitents with primary parapharyngeal space tumors treated from January 2006 to December 2008 in Chinese PLA General Hospital was performed.Among the 40 patients,there were male 22 patients,female 18 patients,age ranged from 1 - 77,median 42 years old.CT scan combined with MRI was helpful to diagnose the parapharyngeal space tumor and make surgical plan. The surgical approaches include: trans-oral in 1 patient,trans-cervical approach in 22,transcervical-parotid approach in 8,vertical ramusosteotomy approach in 1,tanscervicalpartial bone resection in the angle of mandible in 4,transparotid approach in 2,and transcervical in combination with post auricle craniotomy approach in 2.Results All 40 patients had undergone surgical treatment.Postoperative histopathology showed benign in 28 patients and malignant in 12 patients.The tumors originating from salivary glands were in 15 patients,neurogenic tumors in 12 patients and tumors originating from other tissues were in 13 patients.Among 28 patients with benign tumors,23 had been cured with one operation,without recurrence during following-up of 13 -47 months,with a median of 39 months.Among 12 patients with malignant tumors,6 patients alive( with following-up of 24 -50 months and a median of 36 months ),3 patients died in half year after operation and 3 patients lost. The post-operative complication included cerebrospiral fluid leak in one patient,operative field infection in 2 patients,and vagus nerve injury in 3 patients.Conclusions Surgery is the first choice for parapharyngeal space tumors.Transcervical approach alone can apply to most tumors and a broader approach is indicated for malignant or large benign tumors.The prognosis is good for the benign lesions,but poor for the malignant tumors.