咽旁间隙恶性肿瘤的诊断与治疗

目的 探讨咽旁间隙恶性肿瘤的临床特征、诊断和治疗方法。方法 回顾性分析5例咽旁间隙恶性肿瘤患者的临床资料，均行颈部B超及CT扫描，3例行增强MRI检查；均行颈侧入路切除肿瘤，其中2例同期行同侧功能性颈淋巴结清扫术，3例术后行放射治疗；术中快速病理、术后常规病理及免疫组织化学检查，明确诊断。结果 5例中恶性神经纤维瘤1例，恶性神经鞘膜瘤1例，腮裂癌1例，未分化癌1例，滑膜肉瘤1例；术前B超、CT、增强MRI检查可以明确肿瘤的位置、大小、形态、边界及与周边结构的关系，有助于手术入路及手术方式的选择；5例术后随访，3例随访1年内无复发，1例随访3年后死亡，1例半年后失访。结论 咽旁间隙恶性肿瘤组织类型复杂多样，预后差，颈部B超、CT扫描、增强MRI检查对肿瘤的诊断有帮助，选择合适入路肿瘤切除术是首选的治疗方法，综合治疗对患者的预后很关键。

Diagnosis and treatment of the malignant parapharyngeal space tumors

Objective To study the clinical characteristics,diagnosis and treatment of the malignant parapharyngeal space tumors. Methods A retrospective study of 5 patients with primary malignant parapharyngeal space tumors treated from 2000 to 2013 was performed. All the 5 patients received B-ultrasound and CT scan,while 3 patients underwent further enhanced MRI scanning. The transcervical approach surgery was applied in 5 patients and functional neck dissection was performed in 2 patients. Postoperative radiotherapy were applied in 3 patients. Final diagnosis was reached by frozen section and pathological studies. Results There were one malignant neurofibroma,one malignant peripheral nerve sheath tumor,one branchial cleft carcinoma,one synovial sarcoma,and one undifferentiated carcinoma. Preoperative imaging studies were very important for precise tumor localization and its relation to adjacent structures. 3 patients were alive in 1-year following-up,however,1 patient died 3 years later and 1 patients was gone half a year later after the operation. Conclusion The malignant parapharyngeal space tumors are various in histopathology. B-ultrasound,CT scan and enhanced MRI study are helpful for diagnosis. Appropriate approach is key in the surgery of parapharyngeal space tumors. Comprehensive treatment is very important to the prognosis.