颈腮入路及其拓展术式在咽旁隙肿瘤手术中的应用

目的探讨颈腮入路及其拓展术式在咽旁隙肿瘤手术中的应用价值。方法回顾性分析2009年1月~2018年4月行经颈腮入路手术治疗的29例咽旁颅底肿瘤患者的临床资料。其中2例颈腮入路切除颅底咽旁隙复发肿瘤，1例颈腮入路下颌骨升支离断再复位切除侵犯颅底咽旁隙巨大复发性多形性腺瘤，2例颈腮入路下颌骨升支后缘部分切除暴露咽旁隙切除侵犯颅底的多形性腺瘤，22例颈腮入路将下颌骨前上牵拉暴露颅底咽旁隙并切除该部位肿瘤，2例颈腮入路结合内镜辅助切除颅底咽旁隙复发神经来源肿瘤。结果本组29例患者皆成功手术，其中恶性肿瘤2例，良性肿瘤27例；27例良性肿瘤中，多形性腺瘤25例，复发神经来源肿瘤2例。25例多形性腺瘤病例中3例为复发多形性腺瘤；本组病例均无出血、张口受限等不良并发症。复发良性肿瘤病例中2例行术后预防气管切开，术后1个月皆拔除气管套管。2例颅底咽旁隙复发恶性肿瘤中手术后最短存活时间为1年7个月，最长3年。结论颈腮入路不仅适应于大部分咽旁隙肿瘤的切除，而且可以根据肿瘤的性质和累及颅底的范围进行适当拓展，以实现有效切除肿瘤和保证重要解剖结构的安全。

Application of transcervical transparotid approach and expansion operation in the surgical treatment of parapharyngeal space tumors

ObjectiveTo explore the application value of transcervical transparotid approach (TCTPA) and expansion operation in the surgical treatment of parapharyngeal space tumors.MethodsClinical data of 29 patients with parapharyngeal skull base tumors surgically treated via TCTPA from Jan. 2009 to April 2018 were analyzed retrospectively. Of them, TCTPA was adopted to resect recurrent tumor of skull base and parapharyngeal space in 2 cases, TCTPA combined with interruption and reposition of mandibular ascending branch in one case of recurrent pleomorphic adenomas in the parapharyngeal space with skull base involved, TCTPA combined with partial posterior margin removal of the mandibular ascending branch in 2 of pleomorphic adenomas in the parapharyngeal space with skull base involved, TCTPA combined with forward retraction of mandible in 22 cases, endoscope assisted TCPTA in 2 cases with recurrent neurogenic tumor in the parapharyngeal space.ResultsSurgical resection was performed successfully in all the 29 patients including 2 with malignant tumors and 27 with benign tumors. Among 27 benign tumors, 25 were pleomorphic adenomas and 2 were recurrent neurogenic tumors. Of the 25 pleomorphic adenomas, 3 were recurrent. No postoperative complications such as bleeding and restriction of mouth opening occurred. Postoperative tracheotomy was performed in 2 cases of recurrent benign tumors, and tracheal decannulation was achieved one month after surgery. The survival time of one patient with recurrent malignant tumor was 3 years, while that of another one was 1 year and 7 months.ConclusionTCTPA is not only suitable for resection of most parapharyngeal space tumors, but also can be extended appropriately according to the nature of the tumors and the involved extent of the skull base in order to achieve effective tumor removal with protection of important anatomical structures.