72例咽旁隙肿瘤的临床诊治

目的 分析并总结咽旁隙肿瘤的临床特点、手术方法及预后情况。方法 回顾性分析南京医科大学第一附属医院2012年11月—2022年11月收治的咽旁隙肿瘤患者的临床资料，排除影像学资料不全及失访的患者共筛选到72例，其中男36例，年龄27~72岁，平均年龄（46.06±1.72）岁；女36例，年龄21~77岁，平均年龄（53.67±4.88）岁。所有患者均根据术前查体及影像学检查制定手术方案，经口径路27例，颈侧径路45例。术后随访2～135.9个月，中位随访时间54.38个月。统计分析临床、影像及手术资料。结果 72例患者术后病理为良性肿瘤63例，其中上皮源性肿瘤29例，神经源性肿瘤30例，其他组织来源良性肿瘤4例；4例复发，其中2例神经鞘瘤，2例多形性腺瘤，余59例恢复良好；恶性肿瘤9例，其中鳞状细胞癌5例，恶性梭形细胞瘤1例，恶性淋巴瘤1例，滑膜肉瘤1例；3例复发。尽管良性咽旁隙肿瘤经口内镜手术存在囊内分块切除的情况，但相比整块切除的患者并未增加复发风险（P=0.381）。结论 咽旁隙肿瘤位置深在，临床结构复杂，良性肿瘤预后可，恶性肿瘤易复发转移，预后较差。根据术前查体和影像学检查制定手术径路至关重要。手术以颈侧开放径路为主要方式，内镜辅助径路需严格把握适应证，肿物长径较大时在包膜完整的情况下作囊内分块切除是可行的。

Clinical analysis of 72 cases of parapharyngeal space tumors

Objective To explore the clinical features, surgical methods, and treatment outcomes of patients with parapharyngeal space tumors.Methods Clinical data of patients with parapharyngeal space tumors admitted to the First Affiliated Hospital of Nanjing Medical University from November 2012 to November 2022 were retrospectively analyzed. A total of 72 patients with complete imaging and follow-up data were screened out, including 36 males, aged 27-72 years old, with an average age of (46.06±1.72)years old and 36 females, ranging from 21 to 77 years old, with an average age of (53.67±4.88)years old. According to preoperative physical examination and imaging examination, the surgical plan was made for all patients, 27 cases by oral approach and 45 cases by cervical lateral approach. Postoperative follow-up lasted from 2 to 135.9 months, with a median of 54.38 months. Their clinical, imaging, and surgical data were statistically analyzed.Results Of the 72 patients, postoperative pathology confirmed benign tumors in 63 cases, including epithelial-derived tumors in 29, neurogenic tumors in 30, and tumors derived from other tissues in 4. Of them, 4 cases recurred, including 2 of schwannoma, 2 of pleomorphic adenoma, and 59 cases recovered well. There were 9 cases of malignant tumors, including 5 of squamous cell carcinoma, 1 of malignant spindle cell tumor, 1 of malignant lymphoma and 1 case of synovial sarcoma. And 3 cases of them relapsed. Despite intracapsular resection during oral endoscopic surgery for benign parapharyngeal space tumor, there was no increased risk of recurrence compared with en bloc endoscopic resection (P=0.381).Conclusions The parapharyngeal space tumor is deep in the location, the clinical structure is complex, the prognosis of benign tumors is reasonable, while the prognosis of malignant tumors is poor due to complicated pathological results. It is essential to determine the surgical approach according to preoperative physical examination and imaging examination. The primary surgical method is the open cervical approach, and the endoscopy-assisted approach needs to grasp the indications strictly. Intracapsular resection with an intact capsule is feasible when the tumor is large.