Analysis of clinical diagnosis and treatment of 112 cases of parapharyngeal space tumors
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摘要: 目的:探讨咽旁间隙肿瘤的诊断、治疗与手术入路的选择。方法:回顾性分析112例接受手术治疗的咽旁间隙肿瘤患者的临床资料,包括其临床症状、体征、病理类型、影像学检查、术后并发症及其处理、手术入路的合理选择。结果:CT、MRI和数字减影血管造影(DSA)能明确肿瘤的大小、位置及与周围组织结构的关系;术后组织病理学类型多样,良性肿瘤98例,其中涎腺源性肿瘤52例,神经源性肿瘤33例,其他良性肿瘤13例,随访3年,涎腺多形性腺瘤局部复发3例,神经纤维瘤复发1例,经再次手术治愈;恶性肿瘤14例,其中8例生存5年,2例(腺样囊性癌、癌在多形性腺瘤中)术后2年半肿瘤局部复发,再次手术并辅以术后放疗,随访3年,无再复发,其他4例随访1~3年未见复发;术后周围性面瘫25例,舌下神经麻痹3例,迷走神经损伤1例,Horner综合征2例,Frey综合征4例,腮瘘3例,术腔积液感染1例。结论:CT、MRI和DSA对咽旁间隙肿瘤的诊断与鉴别诊断具有重要意义,熟悉咽旁间隙的解剖结构,给予正确的术前检查与评估,选择恰当的手术径路是治疗咽旁间隙肿瘤的关键。Abstract: Objective:To explore the diagnosis, treatment and surgical approaches of parapharyngeal space tumors. Method:This retrospective study consisted of 112 patients with parapharyngeal space tumors underwent surgeries. The data included clinical symptoms and signs, pathological types, imaging examinations, surgical approaches and postoperative complications. Result:Computerized tomography (CT), magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) made clear the tumor size, localization and its relation to adjacent structures. The postoperative histopathology varied and showed benign in 98 cases consisting of salivary gland tumors (52 cases),neurogenic tumors(33 cases) and other types (13 cases). During the 3 years follow-up period, local recurrence appeared in 3 patients with salivary pleomorphic adenoma and 1 patient with neurofibromatosis. These recurrent tumor cases were cured with second surgery. In 14 patients with malignant tumors reported, 8 cases survived for 5 years, 2 cases (1 adenoid cystic carcinoma and 1 carcinoma in pleomorphic adenoma) recurred in the two and a half years cured with second surgery affiliated radiation therapy through 3 years follow-up time and the rest were followed up 1 to 3 years without recurrence. Peripheral facial paralysis was observed in 25 patients, and 3 patients experienced hypoglossal nerve palsy. Only 1 patient encountered vagus nerve injury, and 2 patients appeared Horner's syndrome, and 4 patients endured Frey syndrome. Gills leakage was discovered in 3 cases and cavity infection was noted in 1 patient. Conclusion:CT,MRI and DSA were important in the diagnosis and differential diagnosis of parapharyngeal space tumors. The key to successful treatment is knowing the anatomy of the parapharyngeal space, preoperative assessment and appropriate surgical approach.
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Key words:
- parapharyngeal space tumors /
- diagnosis /
- surgical treatment
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