头颈部神经鞘瘤23例临床分析

目的：探讨头颈部神经鞘瘤的临床特征,以提高对头颈部神经鞘瘤的诊治水平。方法：23例均行手术切除,其中颈侧切开切除颈部肿瘤15例,鼻侧切开切除鼻腔肿瘤1例,经口径路切除肿瘤3例,2例面神经鞘瘤分别经中耳乳突中后颅窝联合径路和乳突根治径路切除,1例位于梨状窝的神经鞘瘤在食管镜下钳取完整取出,1例气管内神经鞘瘤行气管切开切除。结果：20例术后随访3个月－7年,19例无复发;1例鼻腔、鼻窦肿瘤术后3年复发。1例术后出再霍纳征,2个月后消失,1例术后出现声嘶。结论：神经鞘瘤术前诊断困难,确诊有赖于病理检查;一旦确诊应尽早手术完整摘除,尽可能保护神经功能,避免并发症的发生。

An analytical study and report on 23 cases of neurolemmoma in the head and neck

Objective:To improve the understanding of the diagnosis and treatment of neurolemmoma in the head and neck by exploring its clinical features.Method:Among all cases treated surgically,15 cases of neurolemmoma in the neck were by the approach of lateral pharyngotomy,one case of neurolemmoma in the nasal cavity by lateral rhinotomy,three cases by mouth.Two cases of facial neurolemmoma were resected by the combined approach(mastoid process?middle cranial fossa and posterior cranial fossa)and radical mastoidectomy respectively.One case of neurolemmoma in the pyriform sinus was completely removed by the forceps under esophagoscope.One case of neurolemmoma in the trachea was removed by tracheotomy.Result:Twenty cases were followed up from 3 months to 7 years and 19 cases did not recurre.One case of neurolemmoma in the nasal cavity and sinus recurred 3 years after operation.One case developed Horner's syndrom postoperatively and disappeared after two months.One case developed hoarseness.Conclusion:It is difficult to diagnose neurolemmoma before operation. Diagnosis of the disease is based on pathological examination.Resection of the tumor should be performed as soon as possible under careful protection of the function of the nerve in order to avoid severe complications.