咽旁间隙肿瘤及手术入路

为探讨咽旁间隙肿瘤的手术方法及入路的选择。报告６６例经各种手术入路治疗的良、恶性肿瘤。结果表明，经颈或经颈合并下颌及正中裂开外旋入路较之其他几种手术入路具有手术适应证广、安全、术后并发症少等优点。认为经颈或经颈合并下颌正中裂开外旋入路是一种安全、彻底切除咽旁间隙原发肿瘤效果最好的入路。     

咽侧间隙巨大骨外骨瘤1例并文献复习

<正>骨外骨瘤症状不明显,好发于颅骨、面部扁骨与副鼻窦(尤其是额窦与筛窦),很少累及四肢骨,发生于颈部者罕见。2011年9月,我院收治咽侧间隙孤立性骨瘤患者1例,术后20个月未见复发,报告如下。1资料与方法1.1一般资料患者,女,入院时49岁,自骨科转入我科,因颈部酸痛伴头晕1 d来院检查,行CT检查发现环枢椎右前方、右侧咽旁间隙内见不规则混杂密度,边界清,密度不均,内见脂性、钙化及软组织     

咽旁间隙肿瘤

目的讨论临床罕见的咽旁间隙肿瘤。方法总结１９８６年～１９９７年７月收治的５９例患者的回顾性资料。结果原发性咽旁间隙肿瘤中，以神经源性肿瘤居多，约占６０％。高分辨ＣＴ及ＭＲＩ对临床诊断及手术径路的选择有重要作用。颈侧切开广泛应用于７５％的良性病变；应用下颌骨正中裂开切除２例局限于隙上部的良性肿瘤和１例侵及颅底的颈动脉体瘤；应用侧颅底入路切除１例起源于颈静脉孔生长至咽旁间隙的神经鞘瘤。结论认为经口径路仅用于较小的肿瘤切除；经颈腮腺径路主要用于侵入咽旁间隙的腮腺深叶肿瘤的切除；经颈下颌骨正中裂开径路是切除咽旁间隙特殊肿瘤安全有效的入路。     

Parapharyngeal space foreign body

We present a case of an unusual toothbrush foreign body in the parapharyngeal space in a 1.5-year-old child. Children are most affected by this kind of trauma. Quicker and exact diagnosis guarantee proper treatment and recovery. The toothbrush had broken and one-third (about 6 cm) of it was left in the child’s mouth, causing some swallowing problems. We do not observe any injury of neurovascular structures or inflammation complications. Under general anesthesia, neck exploration was undertaken and the toothbrush removed. External exploration of the neck is the method of choice in the treatment of big parapharyngeal space foreign body as we demonstrated in our case. This method guarantees a good exposure of the neurovascular structures of the neck.     

咽旁隙肿瘤手术路径的研究进展

咽旁隙是头颈部重要的软组织间隙,有许多重要的血管及神经通过,其位置深在,结构复杂,手术暴露困难。咽旁隙肿瘤虽然临床发病率不高,主要以良性肿瘤为主,但其病理类型多样,且生长的部位及方式都有很大不同。在咽旁隙肿瘤手术中,为实现良好暴露,临床开发了多种手术路径,近年来,内镜技术的进步推动了咽旁隙肿瘤手术的发展。为了解临床咽旁隙肿瘤手术的进展,本文对目前咽旁隙肿瘤的手术路径及其发展进行了概括,并在归纳总结多种临床路径后,对一些临床常见咽旁隙肿瘤的手术入路选择提出了建议;同时,对咽旁隙的区域划分和咽旁隙的区域化治疗提出了几点意见。     

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。     

咽旁隙肿瘤手术入路探讨

目的探讨分析咽旁隙肿瘤的诊断和治疗,以提高临床手术水平,减少手术的并发症。方法本研究回顾性分析2000年1月~2012年5月收治的58例患者的临床资料,选择合适的手术途径进行治疗。手术入路有下列4种：口内径路4例,颈侧径路46例,颈腮腺径路6例, 颞下窝径路2例。观察58例咽旁隙肿瘤的术后肿瘤病理类型,探讨分析58例患者术后的并发症,详细记录随访1、3、5年的远期临床疗效。结果31例术前行CT检查,其中24例与术后病理诊断结果一致;28例患者术前行MRI检查,其中有21例与术后病理诊断一致;15例患者术前行B超检查,有8例患者与术后病理诊断结果一致。病理诊断结果发现：良性肿瘤患者44例（75.86%）,恶性肿瘤14例（24.14%）。病理类型中以神经鞘瘤的比例最高。58例患者术后发生的并发症类型有术后感染、术腔积血、迷走神经损伤声带麻痹、舌咽神经麻痹、涎腺瘘、周围性面瘫以及Horner综合征。行口内径路和颈腮腺径路手术的患者发生并发症的比例较高;良性肿瘤患者术后口内径路局部复发1例,再次手术后,随访未见复发。良性肿瘤患者术后3、5年随访无因肿瘤死亡病例。恶性肿瘤患者术后复发6例,失访1例,受访者1、3、5年死亡率分别为14.29%（2/14）,28.57%（4/14）,42.86%（6/14）。结论术前影像学检查对咽旁隙肿瘤的诊断很重要,需外科治疗的病例手术径路非常关键。颈侧径路治疗咽旁隙肿瘤患者,术后并发症少,且疗效显著,是一种最常用而安全的手术入路方式,值得在临床上广泛推广。     

Surgical management of some unusual Parapharyngeal space Tumors

We present out experience with the surgical management of 8 cases parapharyngeal tumors which were successfully operated using various approaches. Most tumors were quite large and presented special surgical challenges to safegaurd important structures and ensure complete tumors excision. Included in the series are 3 rare tumors, a myoepethilioma of the deep lobe of parotid, a Glomus intravagale tumor and a case of extra osseous Ewing’s sarcoma. Depending on tumors location and extent, the transcervical, transparotid and midline mandibulotomy approaches were used and the techniques are described. All patients are currently doing well without any evidence of disease.     

颌颈联合侧入路切除咽旁隙原发巨大肿瘤方法的探讨与评估

本文通过４例经颌颈联合侧入路并切断下颌骨升支，切除咽旁隙原发巨大肿瘤病例的报告，详细介绍了咽旁隙解剖位置的特殊性，原发于该部位肿瘤的临床特点，诊断方法及具体的手术步骤。全面分析了此手术入路的优点与缺陷，并对术中应注意的问题进行了阐述。作者认为此手术入路暴露良好，便于操作，变通术式容易，术后功能障碍较轻，对咽旁隙内原发巨大肿瘤的切除尤为适宜     

咽旁隙和颞下窝肿瘤的外科治疗进展

咽旁隙的原发肿瘤约占头颈部肿瘤的0.5%~1%,绝大多数为良性,涎腺肿瘤和神经源性肿瘤最常见。颈侧入路和经颈-腮腺入路手术是处理咽旁隙肿瘤的主要方法。颞下窝内原发肿瘤较少,且恶性居多。该区域手术可采用颞下窝入路,上颌骨外旋入路、下颌骨外旋入路等。随着内镜辅助下经鼻、经口入路手术技术的进步和机器人手术、影像导航系统的发展,咽旁隙和颞下窝肿瘤的外科治疗呈微创化趋势。耳鼻咽喉科、头颈外科、口腔颌面外科和神经外科等相关专业的多学科合作和内镜辅助下的微创手术是该区域肿瘤外科治疗的发展方向。     

Parapharyngeal abscess: diagnosis and treatment

To study the circumstances of diagnosis, predisposing factors, bacteriology and therapeutic management of parapharyngeal abscesses. This retrospective study over a period of 7 years concerned 16 patients hospitalized in an ENT and Head and Neck surgery department for parapharyngeal abscess. All patients were treated by intravenous antibiotics and steroids for 5–7 days. The length of hospital stay was 6–15 days. Parapharyngeal abscesses associated with peritonsillar and retropharyngeal abscess were all initially aspirated transorally for evacuation and bacteriologic examination. Five patients underwent surgical drainage (two via cervical incision, three by immediate tonsillectomy techniques and one by intra-oral drainage). Two patients presented jugular vein thrombosis. No life-threatening complication was observed. Patients were considered to be cured when cervical CT scan performed on D21-45 was normal. Parapharyngeal abscess is the second most common deep neck abscess after peritonsillar abscess. The diagnosis is both clinical and radiologic. CT scan is the best imaging examination for diagnosis and follow-up of parapharyngeal abscess. Non-complicated parapharyngeal abscesses require first-line medical management (intravenous antibiotics (amoxicillin and clavulanic acid) combined with steroids) and follow-up CT scan.     

Parapharyngeal space tumors: Fifty-one cases managed in a single tertiary care center

Conclusions: Pre-operative planning for parapharyngeal tumors must include meticulous analysis. Factors such as tumor size, distance to cranial base, and relation to neurovascular structures must guide the selection of a surgical approach. Objective: To summarize experience in diagnosis and surgical management of parapharyngeal tumors, analyzing the frequencies of various tumoral types, clinical presentation, choice of surgical approach and outcomes. This study also compares the results with the most relevant case series in the literature. Methods: A retrospective review was performed of the records of 51 patients treated by the team, from 1984–2012. Only primary tumors were included, excluding invasion from adjacent spaces and metastatic disease. All patients underwent imaging studies and surgical resection of the neoplasm. Cytological analysis and arteriography were used on an individualized basis. Surgical excision was performed via different approaches, predominantly through a cervicoparotid route. Results: Benign neoplasms were predominant (80%), and the most frequent tumor was pleomorphic adenoma. FNAC had a 100% accuracy to differentiate benign vs malignant tumors. The most common post-operative sequel was compromise of a cranial nerve, and three patients presented local complications after surgery. After follow-up, only three of 41 patients with benign tumors had recurring disease.     

Parapharyngeal and retropharyngeal space abscess: an unusual complication of chronic suppurative otitis media

Parapharyngeal and retropharyngeal abscess as a complication of cholesteatoma is an uncommon entity. We present the unusual case of a 32-year-old man with chronic suppurative otitis media, presenting with parapharyngeal and retropharyngeal abscess. This was treated with incision and drainage of the abscess followed by modified radical mastoidectomy for chronic suppurative otitis media.     

颈侧径路切除咽旁间隙良性肿瘤

目的分析颈侧径路咽旁间隙手术在良性肿瘤切除中的应用。方法回顾总结北京同仁医院2004年7月～2007年7月19例20次咽旁间隙良性肿瘤切除术。结果20次手术均在全麻下颈侧径路完成,无永久并发症发生。所有患者随访6（6～36）个月以上。19例中1例术后1年3个月复发,再次全麻经颈手术切除。结论颈侧径路是咽旁间隙良性肿瘤切除适用的术式,创伤小且效果好,所有良性肿瘤基本可行颈侧径路解决。     

颞下窝-翼腭窝-咽旁间隙肿瘤手术进路探讨

目的：探讨如何选择最佳手术进路切除颞下窝-翼腭窝-咽旁间隙肿瘤,以提高疗效,减少并发症和后遗症。方法：回顾性分析66例颞下窝、翼腭窝、咽旁间隙肿瘤患者,包括组织学诊断、影像学检查及手术人路。结果：50例良性肿瘤患者术后随访2～5年,均无复发;16例恶性肿瘤患者,术后随访2～5年,生存期不足1年4例,2～4年8例,5年及以上4例。结论：扩大上颌骨切除术适于上颌窦原发恶性肿瘤侵及翼腭窝、颞下窝和（或）咽旁间隙的患者;面正中揭翻术适于鼻腔、鼻窦、鼻咽及翼腭窝良性肿瘤及局限的恶性肿瘤患者;颈侧高位切开下颌骨外旋人路术适于咽旁间隙肿瘤累及翼腭窝和（或）颞下窝的患者;颈颌径路-下颌骨截骨术适于咽旁间隙-颞下窝良、恶件肿瘤侵犯侧颅底及翼腭窝的患者。     

72例咽旁隙肿瘤的临床诊治

目的 分析并总结咽旁隙肿瘤的临床特点、手术方法及预后情况。方法 回顾性分析南京医科大学第一附属医院2012年11月—2022年11月收治的咽旁隙肿瘤患者的临床资料,排除影像学资料不全及失访的患者共筛选到72例,其中男36例,年龄27~72岁,平均年龄（46.06±1.72）岁;女36例,年龄21~77岁,平均年龄（53.67±4.88）岁。所有患者均根据术前查体及影像学检查制定手术方案,经口径路27例,颈侧径路45例。术后随访2～135.9个月,中位随访时间54.38个月。统计分析临床、影像及手术资料。结果 72例患者术后病理为良性肿瘤63例,其中上皮源性肿瘤29例,神经源性肿瘤30例,其他组织来源良性肿瘤4例;4例复发,其中2例神经鞘瘤,2例多形性腺瘤,余59例恢复良好;恶性肿瘤9例,其中鳞状细胞癌5例,恶性梭形细胞瘤1例,恶性淋巴瘤1例,滑膜肉瘤1例;3例复发。尽管良性咽旁隙肿瘤经口内镜手术存在囊内分块切除的情况,但相比整块切除的患者并未增加复发风险（P=0.381）。结论 咽旁隙肿瘤位置深在,临床结构复杂,良性肿瘤预后可,恶性肿瘤易复发转移,预后较差。根据术前查体和影像学检查制定手术径路至关重要。手术以颈侧开放径路为主要方式,内镜辅助径路需严格把握适应证,肿物长径较大时在包膜完整的情况下作囊内分块切除是可行的。