颈部神经鞘瘤32例临床分析

目的：探讨颈部神经鞘瘤的诊断和选择最佳手术入路。方法：对1987年8月－1997年9月心治32例患者进行临床回顾性分析。结果：神经鞘瘤的良性居多占96．85，应用CT及MR泽临床诊断及手术径路的选择的指标作用，采用颈外切开径路者占84％，所有病例随访2年－12年。结论：应根据肿瘤部位，侵犯范围及病理类型选择式术，我们体会对多数颈神经鞘瘤采用颈外切开入路可彻底切除肿瘤又可防止损伤神经血管等重要结构，是较佳的手术入路。     

颈部神经鞘瘤32例临床分析

目的　探讨颈部神经鞘瘤的诊断和选择最佳手术入路。方法　对 1 987年 8月～1 997年 9月收治 32例患者进行临床回顾性分析。结果　神经鞘瘤的良性居多占 96.8% ,应用CT及 MRI对临床诊断及手术径路的选择有指导作用。采用颈外切开径路者占 84.3% ,所有病例随访 2年～ 1 2年。结论　应根据肿瘤部位、侵犯范围及病理类型选择式术。我们体会对多数颈神经鞘瘤采用颈外切开入路可彻底切除肿瘤又可防止损伤神经血管等重要结构 ,是较佳的手术入路。     

咽旁间隙肿瘤的CT和MRI诊断价值

目的分析咽旁间隙肿瘤的CT及MRI表现，以提高该部位病变的诊断及鉴别诊断水平。方法回顾性分析54例经病理证实的咽旁间隙肿瘤的CT及MRI表现。结果神经鞘瘤形态较规则（85．7％），涎腺肿瘤形态多不规则（63．2％），二者边界多清楚。涎腺肿瘤位于茎突前方18例（94．7％），神经鞘瘤位于颈鞘内26例（92．9％）。24例神经鞘瘤使咽旁间隙向两侧移位（85．7％），涎腺肿瘤多向前、内侧移位。涎腺肿瘤中12例（63．2％）小部分伸人腮腺深叶。神经鞘瘤多位于二腹肌后腹的深面（96．4％），涎腺肿瘤多位于二腹肌后腹的浅面（68．4％）。结论肿瘤与茎突、咽旁脂肪间隙、颈鞘、腮腺、二腹肌后腹的关系及肿瘤密度／信号及强化特点对咽旁间隙肿瘤的定位、定性诊断有重要的价值。     

咽旁间隙肿瘤132例临床分析

目的:提高对咽旁间隙肿瘤的诊治水平。方法:对40年间收治的132例咽旁间隙肿瘤的临床资料进行回顾性分析。结果:完整摘除肿瘤128例。出现并发症有8例,其中Horner综合征4例,声带麻痹2例,舌下神经麻痹1例,另1例发生于颈侧及咽侧联合进路切开者,术后出现IX,X,XI,XII颅神经同时麻痹。结论:原发性咽旁间隙肿瘤中,以神经源性肿瘤居多。根据术前检查了解肿块的大小,形态,位置及与周围重要结构的关系,选择合适径路,手术效果满意。颈侧切开为其主要手术径路。     

甲状腺乳头状癌颈淋巴结转移CT评估47例分析

[目的]探讨CT检查诊断甲状腺乳头状癌（PTC）颈淋巴结转移的临床价值及对手术治疗的指导意义。[方法]回顾性分析47例行功能性颈清扫PTC的术前CT结果．并与病理诊断结果对照。[结果]绝大多数淋巴结转移灶有特征性影像学改变。颈中央区淋巴结转移率最高（46．8％），并且小的转移淋巴结CT不能发现而出现5例假阴性。47例患者CT检查灵敏度为86．5％（32／37），特异度90．0％（9／10）。[结论]对PTC初次手术应包括颈中央区淋巴结清扫；对初治时为临床颈侧区淋巴结阴性（cN0），但术前CT提示为颈侧区淋巴结转移阳性的患者，支持行颈侧区淋巴结的选择性清扫。     

咽旁间隙肿瘤治疗相关问题探讨

目的 探讨咽旁间隙肿瘤治疗方案选择.方法 回顾我科1970年1月-2000年1月收治165例咽旁间隙肿瘤的治疗资料,108例单纯手术,44例术后放疗,13例术后放、化疗.颈侧入路111例,下颌骨裂开入路15例,腮腺入路31例,口腔软腭人路8例,3例术后气管切开.结果 165例患者中108例为良性肿瘤,57例为恶性肿瘤.良性肿瘤术后复发9例,恶性肿瘤术后复发18例,远处转移5例.57例恶性肿瘤随访5年以上,24例存活,5例失随,5年生存率为51.2﹪.手术并发症神经麻痹29例,伤口积液感染8例,术后出血2例.结论 手术是咽旁间隙肿瘤治疗的主要方法.手术入路应根据肿瘤的大小、位置和重要血管之间的关系及肿瘤的良恶性来选择,颈侧入路是咽旁间隙肿瘤手术的主要入路,咽旁间隙恶性肿瘤应采用综合治疗.     

颈椎旁神经源性肿瘤手术入路的探讨

背景与目的：颈椎旁神经源性肿瘤多起源于脊神经背根，与颈动脉三角区的颈总动脉，颈内静脉，迷走神经及椎动脉等重要血管神经相互毗邻。其特殊的解剖位置使得手术难度增加，手术进路的选择也就显得尤为重要。本文旨存探讨颈侧手术入路对颈椎旁神经源性肿瘤切除的可行性及其治疗效果。方法：回顾性分析经颈侧入路于术治疗的从1971～2006年我院29例颈椎旁神经源性肿瘤患者的临床资料。结果：本组病例中，良性肿瘤20例，占70．37％（19／27），恶性肿瘤9例，占29．63％（8／27）。本组29例病例中，经颈侧进路切除肿瘤28例，经颈项部切门进路枕部下横切口1例。27例肿瘤全切除的病例中，经颈侧切口进路肿瘤全切除26例，其中胸锁乳突肌前缘切口12例，胸锁乳突肌后缘切口7例，颈胸切口1例，下颌角下做横切口4例，锁上弧形切口2例；经颈项部进路切除肿瘤1例。经颈侧进路肿瘤全切除26例．大部分切除2例，肿瘤全切除率为92．85％（26／28）；在肿瘤全切除病例中，有3例局部复发，1例局部复发伴双肺转移。肿瘤全切除病例的局部复发率为14．81％（4／27）。结论：颈椎旁肿瘤经颈侧切口进路手术具有术野暴露清楚，肿瘤全切除率较高等优点，应为颈椎旁肿瘤切除手术切口进路的首选。     

下颌升支截断切除咽旁间隙巨大肿瘤

目的:探讨咽旁间隙巨大肿瘤的最佳手术入路。方法:经颈侧入路,切除腮腺浅叶同时切断下颌升支,切除咽旁间隙巨大肿瘤12例,肿瘤切除后复位固定下颌升支。术后下颌骨X-线摄片。结果:12例均完整切除肿瘤,1例术后出现Horner综合征,暂时性面瘫11例,无永久性面瘫和其他并发症。术后咬合关系正常,下颌骨对位良好。结论:经颈侧下颌升支截断切除巨大咽旁间隙肿瘤,视野良好、易于暴露,手术并发症少。     

电子鼻咽镜和MRI对鼻咽癌颈淋巴结转移的诊断价值

目的探讨鼻咽镜和MRJ检查诊断鼻咽癌颈部淋巴结转移的价值。方法对185例鼻咽癌患者的临床资料进行回顾性分析。结果185例鼻咽癌患者中有131例出现颈部肿块,占70．81％。颈部肿块位于单侧102例,占55．13％,双侧20例,占15．68％,电子鼻咽镜及MRI检查鼻咽灶分布和咽旁间隙受累与颈淋巴结转移有关,双侧咽旁间隙受累比单侧咽旁间隙受累其双侧颈淋巴结转移率高P〈0．005。以颈部淋巴结的影像学分区为标准：Ⅰ-Ⅵ区和咽后区的转移率分别为2．4％、95．42％、51．15％、11．45％、19．84％、0％和75．57％。结论鼻咽癌患者大多数会出现颈淋巴结转移,鼻咽灶分布与颈淋巴结转移率、大小及在颈部分区之间存在着密切相关性,鼻咽镜检查及MRI在鼻咽癌的诊断中起重要作用。     

内镜经鼻蝶入路手术治疗大型垂体腺瘤

背景与目的：对于大型垂体腺瘤,传统的开颅和经蝶入路手术均难以全切,本文探讨内镜经鼻蝶入路切除大型垂体腺瘤的手术技术。方法：回顾性分析2000年9月-2005年12月间治疗的大型垂体腺瘤患者39例,术前均行头CT、MRI及内分泌学检查,手术采用内镜经鼻蝶入路肿瘤切除术。结果：本组患者无手术死亡,肿瘤全切除23例（60．0％）,近全切除14例（35．9％）,部分切除2例（5．1％）。术后随访6—24个月,症状和内分泌学指标均有所改善,肿瘤复发2例。结论：内镜经鼻蝶手术是治疗大型垂体腺瘤微创、安全的方法。     

TUMORS INVADING PARAPHARYNGEAL SPACE : REFINED IMAGING DIAGNOSIS

ＴＵＭＯＲＳＩＮＶＡＤＩＮＧＰＡＲＡＰＨＡＲＹＮＧＥＡＬＳＰＡＣＥ：ＲＥＦＩＮＥＤＩＭＡＧＩＮＧＤＩＡＧＮＯＳＩＳＺｈｕａｎｇＱｉｘｉｎ庄奇新ＣｈｅｎｇＹｉｎｇｓｈｅｎｇ程英升ＹａｎｇＳｈｉｘｕｎ杨世埙Ｓｈａｎｇｋｅｚｈｏｎｇ尚克中ＹａｎＸｉｎｈｕａ...     

咽旁肿瘤切除术(附29例)

目的探讨如何根据术前诊断选择最佳的手术进路,提高疗效,减少并发症和后遗症。方法本组29例,男性16例,女性13例,年龄18~57岁,中位年龄45。均采用手术治疗及术后化疗或放疗。手术进路:口腔入路、颌颈入路、颈侧高位切开下颌骨外旋入路、颌咽入路、上颌骨掀翻入路、上颌骨加咽旁肿瘤切除。结果病理类型:良性21例,恶性8例,随访5年,良性肿瘤均未见复发,骨肉瘤1例术后2个月复发,上颌窦癌1例术后2年复发,口咽侧壁粘液表皮样癌1例术后6年复发,再次术后2年复发,颌下腺腺样囊性癌术后4年复发并肺转移,未继续治疗,恶性淋巴瘤2例化疗后5年无复发。手术均未出现并发症,术后有暂时性的神经功能障碍,均在半年内恢复。结论口腔入路仅适用于紧邻咽粘膜下小肿瘤、颌颈入路适用于咽旁混合瘤、神经鞘瘤和颈动脉体瘤、颈侧高位切开下颌骨外旋入路适用于腮腺深叶肿瘤及高位神经鞘瘤、颌咽入路适用于恶性肿瘤连同下颌升枝一并切除、上颌骨掀翻入路及上颌骨适用于晚期的上颌窦癌及颅底肿瘤侵入咽旁。     

经口腔超声引导穿刺检查在恶性肿瘤疗后咽后间隙淋巴结肿大和咽旁间隙肿块中的临床价值

目的 探讨经口腔超声引导穿刺细胞病理检查对恶性肿瘤疗后影像学发现咽后肿大淋巴结或咽旁间隙肿块性质的诊断价值。方法 2002—2013年间 55例恶性肿瘤放疗后患者经CT、MR检查发现 44例咽后间隙肿大淋巴结、10例咽旁间隙肿块,PET-CT检查发现咽后肿大淋巴结 1例。50例放疗患者中 46例鼻咽癌、3例食管癌和 1例肺尖癌;4例手术治疗患者分别为甲状腺乳头癌、颊黏膜鳞癌、声带鳞癌及乙状结肠腺癌;1例术后放疗患者为鼻腔嗅神经母细胞瘤。经口腔超声检查发现咽后间隙淋巴结肿大 45例和咽旁间隙肿块 10例的低回声区病灶,并在超声引导监督下肿块穿刺活检。结果 37例咽后间隙肿大淋巴结经穿刺细胞病理学证实为癌,检出率为82%,3例鼻咽癌放疗后咽旁间隙肿块穿刺细胞病理学证实为癌,检出率为30%。结论 经口腔超声引导穿刺细胞病理学检查可作出原发恶性肿瘤疗后淋巴结转移和咽旁间隙复发的细胞病理诊断,有利于提早诊断和提供合理治疗的依据。     

Paranasopharyngeal Space Involvement in Nasopharyngeal Cancer: Dectection by CT and MRI

Paranasopharyngeal tumour extension (PTE) from nasopharyngeal carcinoma (NPC) is staged in its own subgroup in the American Joint Committee on Cancer classification. Most large clinical trials use computed tomography (CT) to stage PTE, but diagnosis relies on indirect signs of tumour invasion such as asymmetry of the parapharyngeal fat. Magnetic resonance imaging (MRI) has the advantage of directly revealing PTE because of its ability to depict the complex anatomical structures that form the boundary of the nasopharynx. The aim of this study was to compare CT and MRI in the identification of PTE and to determine whether the imaging modality used influenced staging of the disease.The MRI and CT scans of 78 patients (156 parapharyngeal regions) with NPC were assessed for PTE. On MRI, PTE was considered to be positive when there was tumour invasion through the complex anatomical structures of the nasopharyngeal wall. When using CT, it was considered positive when there was: (1) distortion of the parapharyngeal fat plane; or (2) extension beyond a line drawn from the medial pterygoid plate to the lateral aspect of the carotid artery. CT scanning and MRI were compared.PTE was judged to be present in 28 of 78 (36%) patients by MRI and in 41 of 78 (53%) scanning by CT when using criterion 1 or 2. An analysis of the discordant findings revealed that MRI was positive in three sides of the nasopharynx in early tumour extension through the pharyngobasilar fascia but not identified with CT by using criterion 1 or 2. MRI was negative in 20 and 21 sides of the nasopharynx that were judged to be positive on CT by using criterion 1 and 2 respectively. In these patients MRI revealed that the positive CT scan was caused by a large tumour compressing but not invading the parapharyngeal fat space, a metastatic lateral retropharyngeal node, or a combination of the two.The imaging modality used for staging NPC has an impact on the staging of PTE. CT scanning suggested the presence of PTE more frequently than MRI because of its inability to distinguish the primary tumour from lateral retropharyngeal nodes, and direct tumour invasion of the parapharyngeal region from tumour compression. The imaging modality and criteria used for staging PTE should be taken into consideration when assessing the results of clinical studies.     

Paranasopharyngeal space involvement in nasopharyngeal cancer: detection by CT and MRI

Paranasopharyngeal tumour extension (PTE) from nasopharyngeal carcinoma (NPC) is staged in its own subgroup in the American Joint Committee on Cancer classification. Most large clinical trials use computed tomography (CT) to stage PTE, but diagnosis relies on indirect signs of tumour invasion such as asymmetry of the parapharyngeal fat. Magnetic resonance imaging (MRI) has the advantage of directly revealing PTE because of its ability to depict the complex anatomical structures that form the boundary of the nasopharynx. The aim of this study was to compare CT and MRI in the identification of PTE and to determine whether the imaging modality used influenced staging of the disease. The MRI and CT scans of 78 patients (156 parapharyngeal regions) with NPC were assessed for PTE. On MRI, PTE was considered to be positive when there was tumour invasion through the complex anatomical structures of the nasopharyngeal wall. When using CT, it was considered positive when there was: (1) distortion of the parapharyngeal fat plane; or (2) extension beyond a line drawn from the medial pterygoid plate to the lateral aspect of the carotid artery. CT scanning and MRI were compared. PTE was judged to be present in 28 of 78 (36%) patients by MRI and in 41 of 78 (53%) scanning by CT when using criterion 1 or 2. An analysis of the discordant findings revealed that MRI was positive in three sides of the nasopharynx in early tumour extension through the pharyngobasilar fascia but not identified with CT by using criterion 1 or 2. MRI was negative in 20 and 21 sides of the nasopharynx that were judged to be positive on CT by using criterion 1 and 2 respectively. In these patients MRI revealed that the positive CT scan was caused by a large tumour compressing but not invading the parapharyngeal fat space, a metastatic lateral retropharyngeal node, or a combination of the two. The imaging modality used for staging NPC has an impact on the staging of PTE. CT scanning suggested the presence of PTE more frequently than MRI because of its inability to distinguish the primary tumour from lateral retropharyngeal nodes, and direct tumour invasion of the parapharyngeal region from tumour compression. The imaging modality and criteria used for staging PTE should be taken into consideration when assessing the results of clinical studies.     

咽旁间隙肿瘤(附61例临床分析)

１９７０－１９８９年间，我院收治了６１例咽旁间隙肿瘤，大部份为良性。ＣＴ扫描对诊断和指导治疗有重要意义。良性肿瘤以手术治为主，本组手术切除４８例，其中良性肿瘤３９例，恶性肿瘤９例，均采取颈外侧进路，５例恶性肿瘤加术后放疗。良性肿瘤术后很少复发，恶性肿瘤的３、５年生存率分别为５３．３％和３６．４％。     

基于磁共振鼻咽癌咽旁间隙侵犯与预后关系的探讨

[目的]探讨基于磁共振鼻咽癌咽旁间隙受侵对预后的影响。[方法]185例M0期鼻咽癌患者,按咽旁间隙的侵犯程度进行划分,无咽旁侵犯记为0级,有咽旁侵犯而无颈动脉鞘区侵犯记为1级,有颈动脉鞘区侵犯记为2级。Kaplan-Meier法计算生存率,Cox模型进行预后多因素分析。[结果]咽旁间隙受侵与颅底骨质破坏有明显相关性（r=0.15,P=0.041）。多因素分析显示咽旁受侵不是独立的预后因素,但颈动脉鞘区受侵是影响鼻咽癌总生存、无远处转移的独立预后因素。[结论]单纯的咽旁受侵不影响预后,颈动脉鞘区受侵是独立预后因素。     

原发性结外淋巴瘤的影像诊断及共性特征分析

目的:探讨原发性结外淋巴瘤(primary extranodal lymphoma,PENL)的共性影像学特征,提高其诊断水平.方法:回顾性分析经病理证实的38例PENL患者的CT及MRI影像资料.结果:38例PENL病例中,发生于头颈部13例,胃肠道10例,骨骼7例,胸部5例,泌尿系3例.20例行CT检查,11例行M...