Wang Xiaomin, Zhang Junjie, Cai Changqi, Wu Guixiang, Zhang Ruijing, Wu Yanqing, Ma Shiyin, Li Hui
Department of Otolaryngology Head and Neck Surgery，the First Affiliated Hospital of Bengbu Medical University，Bengbu，233000，China.
Department of Otolaryngology Head and Neck Surgery，the Second Affiliated Hospital of Bengbu Medical University.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2024 Apr;38(4):298-302. doi: 10.13201/j.issn.2096-7993.2024.04.007.
To explore the selection, efficacy and application of indications for parapharyngeal space tumor resection assisted by plasma and HD endoscopic system through oral approach. The clinical data of 23 patients with parapharyngeal space tumor resection assisted by plasma and HD endoscopic system were retrospectively analyzed in Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Bengbu Medical University from January 2013 to June 2023. All cases were examined by high-resolution CT and MRI before operation, and some cases were examined by CTA or DSA. During the operation, the high definition nasal endoscopic recording system was assisted, and low temperature plasma knife was used in some cases. The follow-up time was from 3 to 115 months, and the median follow-up time was 45 months. There were no deaths in this group. All patients had complete tumor resection. The maximum tumor diameter was as follows: （5.20±1.00） cm, the operation time was（128.70±46.67） min, and the average blood loss was（80.87±32.74） mL. One case of vascular smooth muscle tumor had more bleeding during the operation and was assisted by tracheotomy after operation. One case of nourishing vascular bleeding after operation of giant Schwannoma was investigated and hemostasis + external carotid artery ligation. Bleeding in the remaining cases was below 120 mL. Postoperative pathologies were all benign tumors, including 11 pleomorphic adenoma, 4 schwannoma, 2 base cell adenoma, 1 epidermoid cyst, 1 lymphatic cyst with infection, 1 angiomyoma, 1 solitary fibroma, 1 salivary gland cyst, and 1 tendon giant cell tumor. All patients were followed up. One patient originating from vagal schwannoma had 2-month vocal cord paralysis and 1 recurrence（recurrence of the skull base of schwannoma）. Oral approach assisted by plasma and high-definition endoscopic system is suitable for partial selective resection of benign tumors in parapharyngeal space, which has the advantages of less trauma and rapid recovery. When the tumor is blood-rich, suspected to be malignant, the top of the tumor is deep into the cranial base nerve canal,located outside the internal carotid artery, and larger than 6.0 cm considering pleomorphic adenoma, it is recommended to conduct an external open or auxiliary cervical small incision approach.
探讨经口入路等离子体联合高清内镜系统辅助下咽旁间隙肿瘤切除术的适应证选择、疗效及应用。回顾性分析2013年1月至2023年6月蚌埠医学院第一附属医院耳鼻咽喉头颈外科23例行等离子体联合高清内镜系统辅助下咽旁间隙肿瘤切除术患者的临床资料。所有病例术前均行高分辨率CT及MRI检查，部分病例行CTA或DSA检查。术中辅助高清鼻内镜录像系统，部分病例使用低温等离子刀。随访时间3～115个月，中位随访时间45个月。该组无死亡病例。所有患者肿瘤均完整切除。肿瘤最大直径为（5.20±1.00）cm，手术时间为（128.70±46.67）min，平均出血量为（80.87±32.74）mL。1例血管平滑肌肿瘤术中出血较多，术后行气管切开辅助治疗。1例巨大神经鞘瘤术后滋养血管出血，行探查止血+颈外动脉结扎术。其余病例出血量均在120 mL以下。术后病理均为良性肿瘤，其中多形性腺瘤11例，神经鞘瘤4例，基底细胞腺瘤2例,表皮样囊肿1例，感染性淋巴管囊肿1例，血管肌瘤1例，孤立性纤维瘤1例，涎腺囊肿1例，肌腱巨细胞瘤1例。所有患者均获随访。1例源于迷走神经鞘瘤患者出现2个月声带麻痹，1例复发（神经鞘瘤颅底复发）。经口入路等离子体联合高清内镜系统辅助适用于下咽旁间隙部分良性肿瘤的选择性切除，具有创伤小、恢复快等优点。当肿瘤血供丰富、怀疑为恶性、肿瘤顶部深入颅底神经管、位于颈内动脉外侧、考虑多形性腺瘤直径大于6.0 cm时，建议行开放或辅助颈部小切口入路。
