山东大学耳鼻喉眼学报 ›› 2023, Vol. 37 ›› Issue (2): 26-32.doi: 10.6040/j.issn.1673-3770.0.2022.066

• 论著 • 上一篇    

经口三种入路切除咽旁间隙肿瘤的应用分析

陈明浩1,张秋航2,侯佳蒙3,田秀芬1   

  1. 1.郑州大学第一附属医院 咽喉头颈外科, 河南 郑州 450052;
    2.首都医科大学宣武医院 耳鼻咽喉头颈外科, 北京 100053;
    3.郑州大学第一附属医院 放射科, 河南 郑州 450052
  • 发布日期:2023-03-30
  • 通讯作者: 田秀芬. E-mail:xiufen.tian@126.com

Clinical analysis of three endoscopy-assisted transoral approaches in the operative management of parapharyngeal space tumors

CHEN Minghao1, ZHANG Qiuhang2, HOU Jiameng3, TIAN Xiufen1   

  1. 1. Departmnt of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China;
    2. Department of Otorhinolaryngology Head and Neck Surgery, Xuanwu Hospital Capital Medical University, Beijing 100053, China;
    3. Department of Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
  • Published:2023-03-30

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摘要： 目的 探讨在内镜及等离子辅助下经口切除咽旁间隙肿瘤(PPS)的手术入路的选择。 方法 收集耳鼻咽喉头颈外科2015年3月至2021年12月诊断为咽旁间隙肿瘤的患者56例,经口(EATA)24例,颈侧(EA)32例。统计比较临床及手术资料。 结果 所有肿瘤均完全切除,经口组分为咽后壁入路12例,咽侧壁入路7例,软腭入路5例。术后病理良性54例(96.4%),恶性2例(3.6%)。经口入路的手术时间、出血量少于颈侧组。术后颈侧组有7例出现并发症,经口组中有3例出现并发症(P=0.489)。平均随访(46.04±27.88)个月,仅经口组1例复发。 结论 根据肿瘤的大小和位置选择不同的经口入路,能提供与颈侧入路相当甚至更好的治疗效果,如在手术出血量、手术时间、无颈部瘢痕等方面,但同时也是一项具有挑战性的术式,需要更加的完善。

关键词: 咽旁间隙肿瘤, 经口入路选择, 等离子, 内镜

Abstract: Objective To investigate the transoral approaches selection factors of parapharyngeal space(PPS)tumors assisted by endoscope and low-temperature plasma radiofrequency ablation. Methods We retrospectively collected the data of 56 patients who underwent surgical removal of PPS tumors at The First Affiliated Hospital, between March 2015 and December 2021. The patients were divided into two groups based on the technique used: the endoscopr-assisted transoral approach(EATA)group(n=24)and the external approach(EA)group(n=32). Results Total tumor resection was achieved in all the cases. We designed three kinds of transoral approaches: posterior pharyngeal wall approach(n=12), lateral pharyngeal wall approach(n=7), and soft palate approach(n=5). Postoperative pathology examination confirmed benign tumors in 54(96.4%)cases and malignant tumor in 2(3.6%)cases. The operation time and the bleeding volume in the EATA group were significantly less than those in the EA group. Postoperative complications were noted in 7 cases in the EA group and in 3 cases in the EATA(P=0.489). The mean follow-up time was(46.04±27.88)months. There was only one case of recurrence in the EATA group. Conclusion The transoral approach can provide the same or even better therapeutic effect as the external approach, such as the amount of operative blood loss, operation time, no neck scars and so on, but it is also a challenging operation and needs to be improved.

Key words: Parapharyngeal space tumor, Transoral approach, Radiofrequency ablation, Endoscope

中图分类号: 

  • R739
[1] Bozza F, Vigili MG, Ruscito P, et al. Surgical management of parapharyngeal space tumours: results of 10-year follow-up[J]. Acta Otorhinolaryngol Ital, 2009, 29(1): 10-15
[2] Stambuk HE, Patel SG. Imaging of the parapharyngeal space[J]. Otolaryngol Clin N Am, 2008, 41(1): 77-101. doi:10.1016/j.otc.2007.10.012
[3] Riffat F, Dwivedi RC, Palme C, et al. A systematic review of 1143 parapharyngeal space tumors reported over 20 years[J]. Oral Oncol, 2014, 50(5): 421-430. doi:10.1016/j.oraloncology.2014.02.007
[4] Lombardi D, Ferrari M, Paderno A, et al. Selection of the surgical approach for lesions with parapharyngeal space involvement: a single-center experience on 153 cases[J]. Oral Oncol, 2020, 109: 104872. doi:10.1016/j.oraloncology.2020.104872
[5] Rzepakowska A, Osuch-Wójcikiewicz E, Krupa Z, et al. Surgical treatment results of parapharyngeal space tumors: a report of 22 cases[J]. Otolaryngol Pol, 2018, 72(4): 9-16. doi:10.5604/01.3001.0012.0485
[6] 何龙, 谢景华, 高雄辉. 内镜辅助下经口径路咽旁间隙肿瘤切除术临床分析[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(9): 824-827, 835. doi:10.13201/j.issn.2096-7993.2020.09.013 HE Long, XIE Jinghua, GAO Xionghui. Endoscope-assisted transoral resection of parapharyngeal space tumors: a retrospective study[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2020, 34(9): 824-827, 835. doi:10.13201/j.issn.2096-7993.2020.09.013
[7] 陶磊, 石小玲, 李筱明, 等. 188例咽旁间隙肿瘤的回顾性分析[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(2): 129-133. doi:10.13201/j.issn.1001-1781.2018.02.013 TAO Lei, SHI Xiaoling, LI Xiaoming, et al. Retrospective analysis of 188 cases of parapharyngeal space tumors[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(2): 129-133. doi:10.13201/j.issn.1001-1781.2018.02.013
[8] Chen Z, Chen YL, Yu Q, et al. Excision of tumors in the parapharyngeal space using an endoscopically assisted transoral approach: a case series and literature review[J]. J Int Med Res, 2019, 47(3): 1103-1113. doi:10.1177/0300060518816190
[9] Goodwin WJ Jr, Chandler JR. Transoral excision of lateral parapharyngeal space tumors presenting intraorally[J]. Laryngoscope, 1988, 98(3): 266-269. doi:10.1288/00005537-198803000-00005
[10] Ducic Y, Oxford L, Pontius AT. Transoral approach to the superomedial parapharyngeal space[J]. Otolaryngol Head Neck Surg, 2006, 134(3): 466-470. doi:10.1016/j.otohns.2005.10.003
[11] Khafif A, Segev Y, Kaplan DM, et al. Surgical management of parapharyngeal space tumors: a 10-year review[J]. Otolaryngol Head Neck Surg, 2005, 132(3): 401-406. doi:10.1016/j.otohns.2004.09.062
[12] Chen HH, He ZY, Li G, et al. Endoscopy-assisted transoral approach to resect parapharyngeal space tumors: a systematic review and meta-analysis[J]. Laryngoscope, 2021, 131(10): 2246-2253. doi:10.1002/lary.29458
[13] 王振霖, 张秋航, 李茗初, 等. 内镜经鼻低温等离子射频颅底肿瘤切除术的早期经验[J]. 中华耳鼻咽喉头颈外科杂志, 2015, 50(5): 362-368. doi:10.3760/cma.j.issn.1673-0860.2015.05.004 WANG Zhenlin, ZHANG Qiuhang, LI Mingchu, et al. Early experience of radiofrequency ablation-assisted resection of skull base tumor through an endoscopic endonasal approach[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2015, 50(5): 362-368. doi:10.3760/cma.j.issn.1673-0860.2015.05.004
[14] Andreasen S, Therkildsen MH, Bjørndal K, et al. Pleomorphic adenoma of the parotid gland 1985-2010: a Danish nationwide study of incidence, recurrence rate, and malignant transformation[J]. Head Neck, 2016, 38(Suppl 1): 1364-1369. doi:10.1002/hed.24228
[15] Weis E, Rootman J, Joly TJ, et al. Epithelial lacrimal gland tumors: pathologic classification and current understanding[J]. Arch Ophthalmol, 2009, 127(8): 1016-1028. doi:10.1001/archophthalmol.2009.209
[16] 胡益, 陈坤垒, 唐鸣, 等. Ⅰ型神经纤维瘤病侵及咽旁间隙1例[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(8): 758-760. doi:10.13201/j.issn.2096-7993.2020.08.019 HU Yi, CHEN Kunlei, TANG Ming, et al. Neurofibromatosis type Ⅰwith parapharyngeal space invasion: report of one case[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2020, 34(8): 758-760. doi:10.13201/j.issn.2096-7993.2020.08.019
[17] Yohay KH. The genetic and molecular pathogenesis of NF1 and NF2[J]. Semin Pediatr Neurol, 2006, 13(1): 21-26. doi:10.1016/j.spen.2006.01.007
[18] Leroy K, Dumas V, Martin-Garcia N, et al. Malignant peripheral nerve sheath tumors associated with neurofibromatosis type 1: a clinicopathologic and molecular study of 17 patients[J]. Arch Dermatol, 2001, 137(7): 908-913
[19] Wise JB, Cryer JE, Belasco JB, et al. Management of head and neck plexiform neurofibromas in pediatric patients with neurofibromatosis type 1[J]. Arch Otolaryngol Head Neck Surg, 2005, 131(8): 712-718. doi:10.1001/archotol.131.8.712
[20] 文锋, 沈泓, 高为华, 等. 72例咽旁间隙肿瘤患者的诊疗分析[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(17): 1343-1347, 1351. doi:10.13201/j.issn.1001-1781.2018.17.012 WEN Feng, SHEN Hong, GAO Weihua, et al. Analysis and surgical treatment of 72 cases of parapharyngeal space tumors[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(17): 1343-1347, 1351. doi:10.13201/j.issn.1001-1781.2018.17.012
[21] 朱华明, 关建, 茆松, 等. 低温等离子射频消融辅助咽旁间隙良性肿瘤切除的应用分析[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 28-33. doi:10.6040/j.issn.1673-3770.1.2020.086 ZHU Huaming, GUAN Jian, MAO Song, et al. Clinical analysis of low-temperature plasma radiofrequency ablation for benign tumors in the parapharyngeal space[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(2): 28-33. doi:10.6040/j.issn.1673-3770.1.2020.086
[22] Panda S, Sikka K, Thakar A, et al. Transoral robotic surgery for the parapharyngeal space: expanding the transoral corridor[J]. J Robot Surg, 2020, 14(1): 61-67. doi:10.1007/s11701-019-00932-3
[23] Lim JY, Park YM, Kang MS, et al. Comparison of surgical outcomes of robotic and conventional approaches in patients with pre- and poststyloid parapharyngeal space tumors[J]. Ann Surg Oncol, 2020, 27(11): 4535-4543. doi:10.1245/s10434-020-08536-0
[24] Li SY, Hsu CH, Chen MK. Minimally invasive endoscope-assisted trans-oral excision of huge parapharyngeal space tumors[J]. Auris Nasus Larynx, 2015, 42(2): 179-182. doi:10.1016/j.anl.2014.10.010
[25] 王振霖, 张秋航, 刘俊其, 等. 基于解剖平面的内镜经口入路咽旁段颈内动脉定位方法及临床应用[J]. 解剖学报, 2020, 51(5): 677-681. doi:10.16098/j.issn.0529-1356.2020.05.007 WANG Zhenlin, ZHANG Qiuhang, LIU Junqi, et al. A transoral endoscopic approach to locate the parapharyngeal segment of the internal carotid artery[J]. Acta Anatomica Sinica, 2020, 51(5): 677-681. doi:10.16098/j.issn.0529-1356.2020.05.007
[26] Sun XC, Yan B, Truong HQ, et al. A comparative analysis of endoscopic-assisted transoral and transnasal approaches to parapharyngeal space: a cadaveric study[J]. J Neurol Surg B Skull Base, 2018, 79(3): 229-240. doi:10.1055/s-0037-1606551
[27] Ferrari M, Schreiber A, Mattavelli D, et al. Surgical anatomy of the parapharyngeal space: Multiperspective, quantification-based study[J]. Head Neck, 2019, 41(3): 642-656. doi:10.1002/hed.25378
[28] 朱慧涛, 蔡晓岚, 齐君君, 等. 鼻咽部累及咽旁间隙巨大多形性腺瘤一例[J]. 山东大学耳鼻喉眼学报, 2016, 30(6): 113-114.doi:10.6040/j.issn.1673-3770.0.2015.445 ZHU Huitao, CAI Xiaolan, QI Junjun, et al. Giant polymorphic adenoma involving the nasal and pharyngeal spaces in one case[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2016, 30(6): 113-114. doi:10.6040/j.issn.1673-3770.0.2015.445
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