Pang W T, Wu W M, Huang D L, Liu L F
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
Department of Otorhinolaryngology Head and Neck Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Jul 7;55(7):677-682. doi: 10.3760/cma.j.cn115330-20191209-00751.
To study the clinical features, diagnosis and treatment of vagal paraganglioma in parapharyngeal space. Nine cases with vagal paraganglioma in parapharyngeal space were retrospectively analyzed who were diagnosed and treated between January 2006 and December 2018 in Department of Otorhinolaryngology Head and Neck Surgery, Beijing Friendship Hospital and the First Medical Center, Chinese PLA General Hospital. There were 6 males and 3 females, aged from 24 to 50 years old. The main symptoms in the 9 patients were hoarseness and neck mass, and the secondary symptoms were irritating cough, cough on drinking and dysphagia. The main sign was a well-circumscribed round mass, tough in texture, with or without ipsilateral lateral oropharyngeal wall uplift and vocal cord paralysis. The tumors were located between the bifurcation of the carotid artery and the jugular foramen in 7 cases and intruded into jugular fossa in 2 cases. All the 9 patients underwent head and neck enhancement CT and MRI and 7 cases received digital subtraction angiography (DSA) examination and balloon occlusion test. The imaging features were tumors with rich blood supply in the parapharyngeal space of the upper neck, and the tumors were heterogeneous enhanced with contrast CT scan and enhanced MRI, which were closely related to the internal carotid artery, external carotid artery and jugular vein. Among these 9 patients, 8 underwent surgical resection of tumors, including complete tumor resection in 7 cases and partial tumor resection in 2 case. One patient underwent partial tumor resection after being transferred to vascular surgery. There was no recurrence in 7 patients with complete tumor resection and slow growth was shown in 2 patients with partial tumor resection. Posterior cranial nerve injury occurred in 2 patients and stroke in 1 patient due to intraoperative ligation of internal carotid artery. Vagal paraganglioma in the parapharyngeal space is rich in blood supply and closely related to the internal and external carotid arteries, internal jugular vein and posterior cranial nerves. Surgical resection is the first choice for treatments. Choosing a reasonable operative approach for fully exposing the operative field and completely removing the tumor while protecting the internal carotid artery are the keys to successful surgery.
探讨咽旁间隙迷走神经副神经节瘤的临床特点、诊断及治疗方法。回顾性分析2006年1月至2018年12月在北京友谊医院耳鼻咽喉头颈外科及中国人民解放军总医院第一医学中心确诊并治疗的9例咽旁间隙迷走神经副神经节瘤患者的临床资料。其中男性6例，女性3例，年龄24～50岁。9例患者主要症状为声音嘶哑和颈部肿块，次要症状为刺激性咳嗽、饮水呛咳及吞咽困难。主要体征为边界清晰的圆形肿块，质地硬，可伴有同侧咽侧壁隆起及声带麻痹。肿瘤位于颈动脉分叉与颈静脉孔之间7例，侵入颈静脉窝2例。9例患者均行头颈部增强CT及MRI检查，7例行数字减影血管造影（DSA）检查及球囊闭塞试验。影像学表现为上颈部咽旁间隙富血供肿瘤，CT增强扫描及MRI增强扫描肿瘤呈不均匀强化，与颈内动脉、颈外动脉及颈静脉关系密切。9例患者中，8例行肿瘤手术切除，其中7例完整切除肿瘤，2例部分切除肿瘤。1例患者转血管外科后行部分肿瘤切除。7例完整切除肿瘤患者无复发，2例部分切除肿瘤患者肿瘤生长缓慢。2例患者术后出现后组脑神经损伤，1例患者因术中结扎颈内动脉出现脑卒中。咽旁间隙迷走神经副神经节瘤血供丰富，与颈内、外动脉、颈内静脉及后组脑神经关系密切。手术切除是主要治疗方法。选择合理的手术入路充分暴露术野、完整切除肿瘤并保护颈内动脉是手术成功的关键。
