内镜下经口入路保留扁桃体茎突截短术疗效分析

目的 探讨经口入路内镜辅助下保留扁桃体茎突截短术的手术方法及临床疗效。 方法 回顾性分析36例(65侧)茎突综合征患者的临床资料,分析其主诉、病程、误诊情况、茎突长度、扁桃体肿大程度、手术时间、出血量、术后效果,记录患者手术前后的症状改善情况。 结果 36例患者中单侧茎突过长7例,双侧茎突过长29例,共65侧茎突。其中主诉为咽异物感27例,颈肩部疼痛不适12例,咽痛及吞咽痛11例,咽干、咳嗽7例,耳部疼痛3例,面部疼痛1例。病程为20 d~3年不等,平均10个月。被误诊为咽炎20例、胃食管返流4例、甲状腺疾病2例、颈椎病1例、上呼吸道感染1例,误诊率为77.8%。36例患者中扁桃体无肿大14例、Ⅰ度肿大20例、Ⅱ度肿大2例,均无慢性扁桃体炎及扁桃体肿物病史。术前茎突长度为(4.38±0.78)cm,其中最长的为7.89 cm,截短茎突的长度为(2.09±0.93)cm。手术时间(67.08±28.4)min,出血量(8.42±5.58)mL。其中6例患者7侧茎突因位置较深或分离困难行骨折外移。术后随访3个月以上,其中症状消失者27例,症状减轻者4例,症状无变化者4例,失访1例。 结论 经口入路内镜下保留扁桃体茎突截短术保留了正常的扁桃体,手术创伤小、术后疼痛较轻、恢复快、出血少、手术效果好,是治疗茎突综合征有效、安全、微创的手术方式。

Analysis of the clinical efficacy of endoscopy-assisted intraoral removal of an elongated styloid process without tonsillectomy

Objective To investigate the surgical methods and clinical effects of tonsil-sparing styloid process truncation assisted by endoscopy via an oral approach. Methods We retrospectively analyzed the clinical data of 36 patients with styloid process syndrome(65 sides), the data included the main complaints, course of disease, misdiagnosis, length of the styloid process, and the degree of tonsil enlargement. Results Among the 36 patients, 7 had a unilateral styloid process, 29 had bilateral styloid processes, and 65 had styloid processes. The main complaints were pharyngeal foreign body sensation in 27, neck and shoulder pain or discomfort in 12, sore throat and pain associated with swallowing in 11, dry throat and cough in 7, facial pain in 1, and ear pain in 3 patients. The duration of illness ranged from 20 days to 3 years, with an average of 10 months. Of the misdiagnoses, twenty were pharyngitis, four were gastroesophageal reflux, two were thyroid disease, one was cervical spondylosis, and one was upper respiratory tract infection. The misdiagnosis ratio was 77.8%. Among the 36 patients, 14 had no tonsil hypertrophy, 20 had first-degree enlargement, and 2 had second-degree enlargement. None of the patients had a history of chronic tonsillitis or a tonsil mass. The average length of the preoperative styloid process is(4.38±0.78)cm; the longest is 7.89cm. The average length of the truncated styloid process is(2.09±0.93)cm. The duration of surgery was(67.08±28.4)min, and the blood loss during surgery was(8.42±5.58)mL. In six patients, seven side styloid processes were fractured externally due to the deep position or difficulty of separation. After postoperative follow-up for more than 3 months, 27 cases had resolved symptoms, 4 cases had symptom relief, 4 cases had no change in symptoms. One case was lost to follow-up. Conclusion Tonsil-sparing styloidectomy assisted by the endoscopic transoral approach preserves normal tonsils, with less surgical trauma, less pain, faster recovery, less bleeding, and good surgical results. It is effective for treating styloid process syndrome, which is a safe and minimally invasive surgical method.