Sang Jianzhong, Lou Weihua, Zhang Yamin
Department of Otorhinolaryngology-Head and Neck Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2011 Nov;25(21):961-5.
To explore the diagnosis and reasonable surgical approach for parapharyngeal space neoplasms.
From July 2004 to July 2009, a retrospective review of 45 patients with neoplasms of parapharyngeal space was performed. Fourty-five cases were examined by CT, some of them were examined by MRI or DSA. Several surgical approaches were selected. The transcervical approach was used in 35 cases, the transparotid approach was used in 5 cases, the transmandible approach was used in 2 cases, and the transparotid and temporal approach was used in 3 cases.
Among 45 patients, 37 cases (82.22%) were benign and 8 cases (17.78%) were malignant. Neurogenic neoplasms and salivary glands neoplasms were the most common tumors. Using CT, MRI or DSA could obtain useful information about the location, size, shape, density and degree of enhancement of the parapharyngeal space neoplasms, acquire their relationship with styloid and carotid, and make preoperative diagnosis. The diagnostic coincidence rate between preoperative diagnosis and pathological diagnosis was 80% (origin of tissue). All benign tumors were completely resected. A lymphangiomas had recurrence after 1 year,and the second operation had no recurrence. In the 45 cases, 8 cases were malignant tumors. Of 2 patients with malignant mixed tumors, 1 survived disease free after a follow-up of 4 years,and another was still alive with disease after a follow-up of 3 years; Of 2 patients with synovial sarcomas, 1 survived disease free for a follow-up of 3 years, the other one survived disease free after a follow-up of 2 years; 1 patient of nasopharyngeal carcinoma with metastasis in the parapharyngeal space had post-operative radical radiotherapy and survived disease free after a follow-up of 5 years. One patient with chordoma was still alive with disease after a follow-up of 3 years; 1 patient with poorly differentiated squamous cell carcinoma, died of pulmonary metastasis after a 4 year follow-up; 1 case with follicular dendritic cell sarcoma survived disease free after a follow-up of 2 years.
CT, MRI and DSA are essential for the diagnosis and differentiation of parapharyngeal space neoplasm. The transcervical approach is a simple, safe and minimal invasive procedure for resecting parapharyngeal space neoplasms. It is the best approach for treatment of parapharyngeal space neoplasms.
探讨咽旁间隙肿瘤的诊断及合理的手术入路。
回顾性分析2004年7月至2009年7月收治的45例咽旁间隙肿瘤患者的临床资料。45例均行CT检查，部分行MRI或DSA检查。选择多种手术入路，经颈入路35例，经腮腺入路5例，经下颌骨入路2例，经腮腺颞部入路3例。
45例患者中，良性肿瘤37例（82.22%），恶性肿瘤8例（17.78%）。神经源性肿瘤和涎腺肿瘤最为常见。通过CT、MRI或DSA可了解咽旁间隙肿瘤的位置、大小、形态、密度及强化程度，明确其与茎突及颈动脉的关系，做出术前诊断。术前诊断与病理诊断的符合率为80%（组织来源）。所有良性肿瘤均完整切除。1例淋巴管瘤术后1年复发，二次手术后未再复发。45例中恶性肿瘤8例。2例恶性混合瘤患者，1例随访4年无瘤生存，另1例随访3年仍带瘤生存；2例滑膜肉瘤患者，1例随访3年无瘤生存，另1例随访2年无瘤生存；1例咽旁间隙转移的鼻咽癌患者术后行根治性放疗，随访5年无瘤生存。1例脊索瘤患者随访3年仍带瘤生存；1例低分化鳞状细胞癌患者随访4年死于肺转移；1例滤泡树突状细胞肉瘤患者随访2年无瘤生存。
CT、MRI及DSA对咽旁间隙肿瘤的诊断及鉴别诊断至关重要。经颈入路是切除咽旁间隙肿瘤简单、安全、微创的手术方式，是治疗咽旁间隙肿瘤的最佳选择。
