咽旁间隙肿瘤的手术治疗

目的：探讨咽旁间隙肿瘤的诊断、治疗和手术入路的选择。方法：回顾性分析接受手术治疗的34例咽旁间隙肿瘤患者的临床资料，包括症状、体征、组织学诊断、影像学检查和手术进路。结果：88．2％肿瘤为良性。16例起源于腮腺，神经源性肿瘤14例。颈侧进路26例；经口腔进路5例，颈侧及口咽联合进路2例；颞下窝入路1例。32例完全切除肿瘤。术后并发Horner综合征3例，声带麻痹5例，面瘫3例。术侧声带和舌下神经同时麻痹1例。随访13个月～10．5年，34例中30例治愈，1例好转，术后复发3例(均为多形性腺瘤)。结论：采用颈侧进路，能安全彻底切除咽旁间隙肿瘤，经口腔进路仅适合于肿瘤边界清楚、组织明显突出于咽侧且表浅局限者。

Surgery of parapharyngeal space neoplasms

Objective:To study the diagnosis,treatment and the choice of operative entrance for parapharyngeal space neoplasm.Method:In a retrospective study the data of 34 patients between 1993 and 2002 were analyzed with regard to presenting signs and symptoms, histological diagnosis, imaging technique and surgical approach.Result: 88.2% of the tumors were benign. Sixteen tumors originated from salivary glands.Neurogenic tumors were found in 14 patients.Thirty-four patients were treated surgically: the trans-cervical approach was used in 26 cases, trans-oral in 5 cases, the combined transoral-cervical approach in 2 cases, and trans-infratemporal fossa in 1 case. Thirty-two tumors were removed completely.The complications after operation were Horner syndrome (3 cases),vocal cord paralysis (5 cases) and facial nerve palsy (3 cases).One patient had both vocal cord paralysis and hypoglossal nerve paralysis. With the follow-up time of 13 months to 10.5 years, 30 patients had been cured, one patient turned to better, 3 cases had recurrence local tumour (pleomorphic adenoma).Conclusion:The majority of tumors can be excised safely and completely using the trans-cervical approach. Intra-oral excisions should be indicated only for small tumors that tend to pharynx with clear border.