咽旁间隙肿瘤的诊断及手术入路选择

目的:探讨咽旁间隙肿瘤的诊断及手术入路的合理选择。方法:对45例咽旁间隙肿瘤患者的资料进行回顾性分析。患者均行CT及颈部彩超检查,部分患者行MRI或DSA检查。采用的手术入路分别为:颈侧切开入路35例,腮腺入路5例,颈颌入路2例,颞骨加腮腺入路3例。结果:45例患者中良、恶性肿瘤分别为37例(82.22%)和8例(17.78%),其中以神经源性及涎腺来源最为常见。应用CT、MRI和DSA明确肿瘤的位置、大小、形态、密度、强化程度及肿瘤与茎突和颈动脉的关系,作出术前诊断,其与术后病理诊断的符合率为80%(组织来源符合率)。37例良性肿瘤完整切除,1例淋巴管瘤术后1年复发,再次手术后无复发。8例恶性肿瘤中,2例为恶性混合瘤,1例随诊4年无复发,1例随诊3年,带瘤生存;2例滑膜肉瘤,1例随诊3年无复发,1例随诊2年无复发;1例鼻咽癌咽旁间隙转移,术后给予根治性放疗,随诊5年无复发;1例脊索瘤随诊3年,复发带瘤生存;1例低分化鳞状细胞癌随诊4年,死于肺转移;1例滤泡树突状细胞肉瘤随诊2年无复发;结论:CT、MRI和DSA对咽旁间隙肿瘤的诊断与鉴别诊断具有重要意义。颈侧切开入路简便、安全、创伤小,是咽旁间隙肿瘤手术的最...     

原发性咽旁间隙肿瘤的诊断与治疗

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.     

急性扁桃体炎致甲状腺脓肿、咽旁间隙脓肿一例并文献复习

目的 探讨急性扁桃体炎引起甲状腺脓肿继而导致颈部间隙脓肿的病因,研究其感染可能的发展途径及治疗手段的利弊。 方法 依照CT所示进行颈侧切开、开放所有颈部间隙,充分冲洗引流。 结果 经过颈侧切开,颈部间隙充分开放引流后,患者体温逐日下降,10 d恢复正常。 结论 B超、增强CT是鉴别颈部囊肿与脓肿有效手段,穿刺病理诊断是鉴别的金标准。口腔、颌面部感染同时出现甲状腺囊肿样结节要警惕脓肿形成。颈侧切开、充分冲洗引流是治疗咽旁间隙脓肿的有效手段。     

咽旁间隙肿瘤(附89例临床分析)

目的总结诊治咽旁间隙肿瘤的经验.方法回顾分析咽旁间隙肿瘤89例.术前为32例患者行针吸活检术,50例行CT检查;全部患者均行手术治疗,经腮腺入路29例,经颈入路45例,经颈-下颌骨外旋入路15例,术后全部标本作病理检查.结果针吸活检32例中27例诊断正确,CT检查50例中46例可准确判断肿瘤的位置;组织学检查良性肿瘤72例(81%),以恶性肿瘤、混合瘤多见37(42%).良性肿瘤术后10例复发(14%),恶性肿瘤12例复发或转移(74%).结论术前针吸活检和CT检查对诊断咽旁肿瘤有意义,经腮腺和经颈部入路是最常用手术进路.     

60例咽旁间隙涎腺源性肿瘤的回顾性分析

目的　总结并分析咽旁间隙涎腺源性肿瘤的临床特征、诊断方法、外科治疗方法、术后并发症及预后。方法  回顾性分析郑州大学第一附属医院2010年11月~2019年7月收治的60例原发或侵占咽旁间隙的涎腺源性肿瘤患者的临床资料。结果　60例患者中,男28例,女32例,年龄22~84岁。最常见的临床表现为发现口咽部包块。所有患者均行CT和（或）MRI检查。手术入路方式为经颈侧切开入路40例,经腮腺入路3例,经下颌骨裂开入路8例,经口入路13例。术后并发症7例,多为面神经损伤。60例患者中,术后病理良性52例（86.6%）,恶性8例（13.4%）。52例良性肿瘤随访24～94个月,3例失访,1例复发,再次手术后治愈。8例恶性肿瘤随访25～78个月,中位随访36个月,3例死亡,1例失访。结论　咽旁间隙涎腺源性肿瘤良性多见,首选经颈侧切开入路,预后佳。经口入路创伤小、并发症少,但适应证局限。恶性肿瘤预后差,可选择联合入路并辅助术后综合治疗。     

3D技术在鼻内镜手术精准治疗鼻前颅底恶性肿瘤中的应用

目的 探讨3D技术在鼻内镜手术精准治疗鼻前颅底恶性肿瘤及颅底功能重建手术中的作用。 方法 对21例鼻颅底恶性肿瘤患者术前行鼻窦冠状位CT或MRI扫描,并行3D影像重建及模型打印,根据3D成像及模型了解鼻颅底恶性肿瘤侵及范围、颅底及眶壁骨质的缺损大小形状,制定鼻内镜手术术式、肿瘤精准切除范围及颅底功能精准重建方法。 结果 患者肿瘤均一次手术全切除,其中6例行颅底功能精准重建术,无脑脊液鼻漏及颅内感染并发症。术后病理示鳞癌9例,嗅母细胞瘤5例,腺样囊腺癌3例,横纹肌肉瘤4例。术后行正规放疗,横纹肌肉瘤患者加化疗。经平均随访36个月,未发现肿瘤复发及与本肿瘤相关的死亡。 结论 3D成像及打印模型能清楚显示鼻颅底恶性肿瘤范围、颅底及眶壁骨质缺损的大小及形状,并有助于术者选择最佳内镜手术入路及手术方案,有重要临床指导作用。     

62例咽旁间隙肿瘤临床分析

目的：探讨咽旁间隙肿瘤的诊断和治疗方法及熟悉咽旁间隙解剖与肿瘤关系。方法：回顾性分析62例咽旁间隙肿瘤的临床资料。结果：咽旁间隙肿瘤中病理类型较多,但以神经鞘膜肿瘤比例较大,占41.9%,混合瘤22.6%,畸胎瘤、错构瘤、脊索瘤、恶性淋巴瘤及脑膜瘤等共占35.5%。进行以颈侧入路为主的4种手术入路,2例肿瘤复发（1例神经鞘膜瘤,1例转移癌）,再次手术治愈,其余均一次性手术治愈。结论：咽旁间隙肿瘤临床表现复杂,病理类型多样,肿瘤预后较好。其诊断较难,除症状体征外,CT、MRI及B超对咽旁间隙肿瘤的诊断有重要价值。手术径路是根据患者体征、影像学特征结合肿瘤位置、大小及性质而最终确定。颈侧入路为主要手术途径,气管切开为预防窒息措施。     

改良颈-腮腺入路高位咽旁间隙肿瘤切除术探讨

目的总结改良颈-腮腺入路切除高位咽旁间隙肿瘤的可靠性和安全性。方法回顾性分析经我科手术治疗的35例高位咽旁间隙肿瘤患者,术前均进行增强CT和MRI评估。其中24例采用单纯的颈-腮腺入路完整切除肿瘤,3例颅底受累者采取颈-腮腺入路联合颞枕侧颅底入路,2例混合瘤患者采用颈-腮腺入路联合下颌角部分切除,3例神经鞘瘤和1例淋巴血管瘤尝试采用颈-腮腺入路联合内镜辅助下手术,1例癌肉瘤和颅底受累及1例颈动脉体瘤术中改行联合下颌骨裂开入路。结果术后病理混合瘤13例,神经鞘瘤11例,副神经节瘤4例,颈动脉体瘤4例,淋巴血管瘤1例,脊索瘤1例和癌肉瘤1例。患者随访11个月～10年,无严重并发症,癌肉瘤患者术后13个月出现脑转移死亡。结论多数高位咽旁间隙良性肿瘤可以经传统颈-腮腺入路完整切除,改良的颈-腮腺入路可以得到清晰的术野暴露,完整切除高位咽旁间隙肿瘤,只有在恶性肿瘤或需要颈内动脉重建时才考虑联合下颌骨裂开术。     

咽旁隙神经源性肿瘤88例手术疗效分析

目的 探讨咽旁间隙神经源性肿瘤的术前诊断、手术方法及手术并发症。方法 总结1966-2002年收治的88例咽旁间隙神经源性肿瘤的临床资料。结果 88例咽旁间隙神经源性肿瘤中神经鞘膜瘤73例，占83％，神经纤维瘤15例，占17％。颈部CT扫描及彩色B超检查对诊断有重要价值。经颈侧径路摘除肿瘤75例，经咽侧径路摘除肿瘤12例，经颈侧及咽侧联合径路摘除肿瘤1例，均完整摘除。术后出现神经麻痹9例。结论 颈侧径路是安全、彻底切除咽旁间隙神经源性肿瘤的最佳手术入路。对咽旁间隙巨大肿瘤，应行预防性气管切开术。     

咽旁间隙神经鞘瘤诊断及手术入路选择

目的探讨咽旁间隙神经鞘瘤的诊断与手术入路方式的选择。方法对咽旁间隙神经鞘瘤患者14例病历资料进行回顾性分析,术前根据CT和MRI判断肿瘤与扁桃体包膜距离关系及肿瘤主体位置考虑手术径路,与扁桃体包膜距离≤1cm、肿瘤主体突入到口内者行经口内径路,与扁桃体包膜距离1cm、瘤体主体突向外侧者经颈外径路,手术径路与肿瘤大小关系不大。经口内径路4例,颈外径路10例。结果所有患者均获得顺利手术,术后随访6个月～6年均未见复发。结论颈部CT、MRI及DSA是诊断及鉴别诊断的良好手段,手术径路取决于肿瘤与扁桃体包膜的距离及肿瘤主体位置,无论采取何种径路,均无严重的并发症。     

60例咽旁隙肿块的CT及MRI影像学特征分析

目的探讨咽旁隙肿块的CT及MRI表现,了解其影像学特征。方法回顾性分析2014年6月~2016年6月收治的60例咽旁隙肿块患者的CT及MRI影像学特征,观察肿块的位置、形态、与周围组织关系、密度、信号高低等情况。结果在60例咽旁隙肿块患者中,神经鞘瘤36例、涎腺混合瘤15例、颈动脉体瘤5例、鼻咽癌颅底咽旁隙转移4例。神经鞘瘤表现为包膜完整、边界光滑、呈椭圆形或圆形的肿块,与腮腺深叶间分界清楚,涎腺混合瘤为包膜完整的圆形肿块,与腮腺深叶间没有脂肪间隙,茎突、二腹肌、腭帆张肌等周围组织均出现移位。颈动脉体瘤表现为形态规则的软组织肿块,CT平扫呈等密度、增强后明显强化;MRI扫描,T1W1呈等或稍高于肌肉信号,T2W1呈不均性的高信号,并可见流空血管影像。鼻咽癌颅底咽旁隙转移的MRI显示,T1W1呈低密度信号的椭圆形肿块,增强后高信号内可见坏死囊变区。结论正确地认识咽旁隙肿块的CT及MRI影像学特征,有助于提高其临床诊断率,为咽旁隙肿块的治疗提供一定的依据。     

咽旁隙肿瘤的诊断及治疗

目的 了解咽旁隙解剖特征，提高咽旁隙肿瘤诊治水平。方法回顾分析近9年收治的45例咽旁隙肿瘤病人临床表现、影像学特征、外科径路、手术所见及手术后并发症，全部病人随访8个月～9年。结果良性肿瘤40例(其中神经源性肿瘤28例)，恶性肿瘤5例。术前CT或MRI能明确肿瘤的大小、位置、扩展范围、以及与周围结构的关系。术后出现伸舌偏斜2例，口角偏斜1例，Hoiner综合征4例，右上肢曲屈障碍1例，3例术后肿瘤复发再次手术治愈。结论原发性咽旁隙肿瘤以神经源性肿瘤多见，MRI和/或CT检查是诊断咽旁隙肿瘤及术前确定手术方案的基础，且MRI检查优于CT。根据病变的部位及特性，手术可选择经口径路、颈侧径路或颈侧联合径路切除肿瘤。     

15例咽旁隙肿瘤回顾性分析

目的 总结15例咽旁隙肿瘤的临床诊治经验,为选择手术适应证、减少手术并发症提供借鉴。方法 15例咽旁隙肿瘤经增强CT和MRI等术前检查予以充分评估后,采用经口径路手术切除5例、经颈侧径路切除6例、经颈侧腮腺径路切除4例。结果 所有患者肿瘤均成功切除,1例术后即刻出现颅底大出血,用明胶海绵等压迫填塞后成功止血;3例恶性肿瘤患者中2例患者术后接受放疗,1例失访,其余患者随访1.5~5年,均无复发。结论 根据肿瘤部位,结合患者需求选择合适手术方式,能彻底切除肿瘤,术前充分的影像学评估对制定手术方案和预防手术并发症至关重要。     

Comparison of CT and MRI in diagnosis of parapharyngeal tumors]

Recently, the usefulness of CT and MRI in diagnosing parapharyngeal tumors has been established. At the same time, several modalities for these imagings, i.e. plane and enhanced CT, T1, 2 weighted MRI and Gadolinium enhanced MRI, have been developed. We compared the image findings of 12 tumors involving the parapharyngeal space with their operative records. T1 was most suited to diagnosing the sites of origins of tumors because of its superior depiction of the internal carotid artery and parapharyngeal fat. Enhanced CT was also superior in depicting these structures, but in cases where the parapharyngeal fat was diminished, or the parapharyngeal fat had been invaded by malignant tumor, enhanced CT was inferior to T1. The spatial resolution of T2 was poor, T2 was thus not useful in diagnosing the sites of origins of tumors. Because tumor intensity tended to be similar to that of fat in Gadolinium enhanced MRI imaging, Gadolinium was not as useful as T1. In diagnosing the extents of tumors, we examined the depiction of both tumor-fat and tumor-muscle interfaces. With regard to the depiction of the tumor-fat interface, enhanced CT and T1 were most useful. In diagnosing the tumor-muscle interface, Gadolinium enhanced MRI was most suitable. The net result is that MRI is superior to CT.     

下颌骨外旋径路切除鼻咽、口咽、咽旁间隙肿瘤——附12例报道

目的探讨鼻咽、口咽、咽旁间隙肿瘤的手术方法。方法对2002年-2006年下颌骨外旋径路手术切除肿瘤并行局部修复治疗的3例鼻咽癌（2例放疗后复发,1例下咽癌术后鼻咽、口咽部巨大重复癌）、5例口咽恶性肿瘤（3例扁桃体鳞癌,2例颊黏膜鳞癌）、4例咽旁间隙肿瘤（1例脂肪瘤,3例混合瘤恶变）进行回顾性分析。术后缺损分别用胸大肌皮瓣修补3例,用游离前臂皮瓣修补4例,组织工程补片修复2例。结果随访8个月至4年,3例鼻咽癌患者中1例术后1年远处转移死亡,2例无瘤生存;3例扁桃体癌中2例无瘤生存,1例局部复发再次手术切除;2例颊黏膜鳞癌无瘤生存;1例脂肪瘤无复发,3例混合瘤恶变患者中1例6个月后死于远处转移,1例带瘤生存,1例无瘤生存。结论下颌骨外旋径路对于暴露鼻咽、口咽、咽旁间隙肿瘤视野良好,肿瘤可直视下完整切除,应用组织工程补片、带蒂或游离组织瓣进行I期修复,手术安全、可靠。     

Surgical indications and approaches for parapharyngeal space tumors

In the 20-years from 1991 to 2010, we pathologically diagnosed 24 subjects with parapharyngeal space tumors by biopsying and/or resecting of 24 tumors. Of these, 18 were benign and 6 malignant. Pleomorphic adenoma and schwannoma predominated, accounting for 7 cases each. Enhanced CT and MRI were very useful in diagnosis, judging involvement and localization, and assessing radiological and pathological tumor diagnosis. Important radiological factors are determining whether tumor origin is pre-or post-styloid, and how the tumor is enhanced in CT or MRI. We treated 15 subjects surgically, telling 9 the diagnosis, and used only biopsy or scans. It is vital in follow-up to determine long-term treatment response.     

Evaluation and surgical approaches to tumors of the parapharyngeal space

BACKGROUND: Tumors of the parapharyngeal space encompass a wide variety of benign or malignant neoplasms. The purpose of this study was to evaluate our experience with the history, diagnosis and management of parapharyngeal tumors. PATIENTS AND METHODS: In a retrospective study the data of 19 patients who underwent surgical excision between 1995 and 2001 were analyzed with regard to presenting signs and symptoms, histologic diagnosis, imaging technique and surgical approach. 12 patients were female, 7 male. The youngest patient was 17, the oldest 72 years of age (mean: 47). RESULTS: Two thirds of the resected tumors were benign. Eight tumors originated from salivary glands, neurogenic tumors were found in 6 patients, malignant lymphomas in two cases. CT was performed in 16 patients, an additional MRI was indicated in 5 patients due to the superior soft-tissue resolution. In one patient arteriography revealed a paraganglioma. Preoperative localization of the tumor was possible in all cases. The transcervical approach was performed in the majority of cases (7). An intraoral excision (4) in combination with a transcervical approach (3), transcervical-tarnsmandibular (1) or a midfacial degloving (2) was performed less frequently. CONCLUSION: Benign parapharyngeal tumors prevail. In the majority of cases they originate from the salivary glands. CT and MRI are the diagnostic procedure of choice to select the surgical approach with the least morbidity. MRI should be preferred since it provides superior soft-tissue resolution, multiplanar imaging, identification of the vascular structures and no exposition to ionizing radiation. Arteriography should be performed if indicated by MRI findings. Incisional biopsy or fine needle biopsy should be performed only in cases which appear to be unresectable. Intraoral excisions should be indicated only for small tumors. The majority of tumors can be excised using the transcervical approach. Excessive tumor growth or tumors growing close to the skull base may indicate an infratemporal approach or a mandibulotomy.     

Parapharyngeal space lesions: with a reference to biopsy

We received seven cases of parapharyngeal space lesions and discussed on necessity of biopsy. Tumors originating in the parapharyngeal space were represented by parotid pleomorphic adenomas which showed bulging of soft palate and tonsillar fossa, and benign neurogenic tumors which showed bulging of the lateral wall of the meso-pharynx. In these cases, preoperative biopsy was not necessary unless the lesion was suspected, of malignancy by CT, MRI and so on. In the case of bulging of soft palate and tonsillar fossa, if CT or MRI finding shows that the tumor is localized in the median portion of the parapharyngeal space and is separated from greater vessels and nerves existing in the parapharyngeal space, therapeutic protocol might be planned after an establishment of histological diagnosis with biopsy. In the case of a bulging lateral wall of the meso-pharynx with a history of malignant neoplasm of the head and neck, lymph node metastasis should be thought about.     

咽旁间隙恶性副神经节细胞瘤的临床分析

目的 总结咽旁间隙恶性副神经节细胞瘤的临床特点，探讨其诊断及治疗方法。方法 回顾性分析解放军总医院耳鼻咽喉头颈外科自2010年1月—2021年12月收治并经病理确诊的咽旁间隙恶性副神经节细胞瘤8例的临床资料，其中男3例，女5例，年龄21~57岁。患者的临床症状无特异性，所有患者术前均行增强CT/MRI及数字减影血管造影(DSA)等影像学检查，其特点是咽旁间隙富血供病变，与颈部大血管关系密切。结果 所有患者均经颈外入路或颅颈联合入路肿瘤切除术及区域性淋巴结清扫术，其中5例患者行1次手术，2例患者行2次手术，1例患者行3次手术。所有患者均无脑血管损伤并发症。7例患者发生局部淋巴结转移，1例患者发生远处转移。1例患者术后行放射治疗，1例行术后化疗。所有患者均无死亡。结论 咽旁间隙恶性副神经节细胞瘤发病少，其治疗是以手术为主，同时需结合肿瘤特点及患者具体情况制定综合治疗方案。