山东大学耳鼻喉眼学报 ›› 2024, Vol. 38 ›› Issue (4): 28-35.doi: 10.6040/j.issn.1673-3770.0.2023.098
• 论著 • 上一篇
后婕,刘丁丁,王涵东,徐峥嵘,钱晓云,高下,俞晨杰
HOU Jie, LIU Dingding, WANG Handong, QIAN Xiaoyun, GAO Xia, YU Chenjie
摘要: 目的 探讨经泪前隐窝-翼突入路切除上咽旁间隙病变的鼻内镜下手术方法、适应证及临床效果。 方法 回顾性总结2016年2月至2021年8月收治的10例上咽旁间隙占位性病变患者在鼻内镜下经泪前隐窝-翼突入路完成手术情况,分析此路径手术运用特点、手术并发症及疗效。 结果 所有患者均在鼻内镜下经泪前隐窝-翼突入路顺利暴露肿瘤。10例中术后病理确诊为海绵状血管瘤3例,术后MRI显示均获全切;淋巴瘤2例、炎性/炎性假瘤4例及鼻咽癌1例,术后MRI显示均为次全切除。随访时间6~28个月,3例血管瘤均无复发;2例淋巴瘤,经化疗均获得完全缓解;4例炎性/炎性假瘤较术后无明显变化;1例鼻咽癌放疗后鼻咽部病灶完全缓解。10例患者术后均出现患侧硬腭麻木的并发症,其中4例患者随访时硬腭麻木未有改善。 结论 经泪前隐窝-翼突入路可有效显露上咽旁间隙,咽鼓管、腭帆张肌、翼内肌及翼内板,可作为该区域重要的解剖参考标志并利于颅底重要结构的保护。该入路可作为上咽旁间隙病变手术的重要供选方案。
中图分类号:
[1] Li LF, London NR Jr, Prevedello DM, et al. Endonasal endoscopic transpterygoid approach to the upper parapharyngeal space[J]. Head Neck, 2020, 42(9): 2734-2740. doi:10.1002/hed.26127 [2] Tanjararak K, Upadhyay S, Thiensri T, et al. Potential surgical exposure of the parapharyngeal internal carotid artery by endonasal, transoral, and transcervical approaches[J]. J Neurol Surg B Skull Base, 2018, 79(3): 241-249. doi:10.1055/s-0037-1607289 [3] Galli J, Rolesi R, Gallus R, et al. Parapharyngeal space tumors: our experience[J]. J Pers Med, 2023, 13(2): 283. doi:10.3390/jpm13020283 [4] 周兵, 黄谦, 崔顺九, 等. 内镜下经鼻泪前隐窝入路切除翼腭窝及颞下窝神经鞘瘤[J]. 中华耳鼻咽喉头颈外科杂志, 2013, 48(10): 802-806. doi: 10.3760/cma.j.issn.1673-0860.2013.10.003 ZHOU Bing, HUANG Qian, CUI Shunjiu, et al. Removal of Schwannoma in the pterygopalatine and infratemperal fossa via endoscopic prelacrimal recess approach[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2013, 48(10): 802-806. doi: 10.3760/cma.j.issn.1673-0860.2013.10.003 [5] 崔昕燕, 陈峰, 钱晓云, 等. 微型高频针状电极在鼻内镜下泪前隐窝入路手术中的应用[J]. 临床耳鼻咽喉头颈外科杂志, 2017(23): 1844-1847. doi:10.1320/j.issn.1001-1781.2017.23.015 Cui XY, Chen F, Qian XY, et al. Application of the microdissection needle for endoscopic prelacrimal recess approach[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2017(23): 1844-1847. doi:10.1320/j.issn.1001-1781.2017.23.015 [6] 周兵, 韩德民, 崔顺九, 等. 鼻内镜下鼻腔外侧壁切开上颌窦手术[J]. 中华耳鼻咽喉头颈外科杂志, 2007, 42(10): 743-748. doi:10.3760/j.issn: 1673-0860.2007.10.006 [7] Orlando P, Locatello LG, Gallo O, et al. Endoscopy-assisted transoral approach for parapharyngeal space tumors: our experience and a systematic review of the literature[J]. World J Otorhinolaryngol Head Neck Surg, 2023, 9(1): 79-90. doi:10.1002/wjo2.55 [8] 赵建东, 文艺, 纵亮, 等. 原发性咽旁间隙肿瘤治疗的回顾性分析[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(8): 743-747. doi:10.13201/j.issn.2096-7993.2020.08.015 ZHAO Jiandong, WEN Yi, ZONG Liang, et al. Retrospective analysis of treatment of primary parapharyngeal space tumor[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2020, 34(8): 743-747. doi:10.13201/j.issn.2096-7993.2020.08.015 [9] Jiang CY, Wang WQ, Chen SW, et al. Management of parapharyngeal space tumors: clinical experience with a large sample and review of the literature[J]. Curr Oncol, 2023, 30(1): 1020-1031. doi:10.3390/curroncol30010078 [10] 陈贤明, 赵敏, 甄泽年, 等. 经口腔上颌结节入路切除咽旁间隙肿瘤[J]. 中国耳鼻咽喉颅底外科杂志, 2011, 17(1): 22-24 CHEN Xianming, ZHAO Min, ZHEN Zenian, et al. Resection of parapharyngeal space tumor through oral maxillary tubercle approach[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2011, 17(1): 22-24 [11] 于龙刚, 王琳, 张胜男, 等. 经口内镜翼下颌皱襞内侧入路咽旁间隙良性肿瘤切除术[J]. 中华耳鼻咽喉头颈外科杂志, 2022, 57(1): 36-41. doi: 10.3760/cma.j.cn115330-20210428-00236 YU Longgang, WANG Lin, ZHANG Shengnan, et al. Transoral endoscopic resection of benign tumors in parapharyngeal space via medial pterygomandibular raphe approach[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2022, 57(1): 36-41. doi: 10.3760/cma.j.cn115330-20210428-00236 [12] 陈明浩, 张秋航, 侯佳蒙, 等. 经口三种入路切除咽旁间隙肿瘤的应用分析[J]. 山东大学耳鼻喉眼学报, 2023, 37(2): 26-32. doi:10.6040/j.issn.1673-3770.0.2022.066 CHEN Minghao, ZHANG Qiuhang, HOU Jiameng, et al. Clinical analysis of three endoscopy-assisted transoral approaches in the operative management of parapha-ryngeal space tumors[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2023, 37(2): 26-32. doi:10.6040/j.issn.1673-3770.0.2022.066 [13] 徐斌, 鲍洋洋, 周水洪. 经口径路机器人辅助咽旁间隙肿瘤切除术的优势与局限性[J]. 中华耳鼻咽喉头颈外科杂志, 2018, 53(10): 794-797. doi: 10.3760/cma.j.issn.1673-0860.2018.10.016 XU Bin, BAO Yangyang, ZHOU Shuihong. The advantage and disadvantage of transoral orbotic surgery for parapharyngeal tumors: a systemic review[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2018, 53(10): 794-797. doi: 10.3760/cma.j.issn.1673-0860.2018.10.016 [14] Liu Q, Wang H, Zhao WD, et al. Endoscopic transnasal transmaxillary approach to the upper parapharyngeal space and the skull base[J]. Eur Arch Otorhinolaryngol, 2020, 277(3): 801-807. doi:10.1007/s00405-019-05761-6 [15] 李海艳, 翟翔, 何京川, 等. 经鼻内镜切除旁中线颅底良性病变的手术入路选择[J]. 临床耳鼻咽喉头颈外科杂志, 2022, 36(5): 352-356. doi:10.13201/j.issn.2096-7993.2022.05.006 LI Haiyan, ZHAI Xiang, HE Jingchuan, et al. Selection of surgical approach for resection of benign lesions of skull base near midline through nasal endoscope[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2022, 36(5): 352-356. doi:10.13201/j.issn.2096-7993.2022.05.006 [16] 郑朝攀, 曾小燕, 张博, 等. 内镜经翼突入路切除中颅底恶性肿瘤30例临床分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(6): 42-48. doi:10.6040/j.issn.1673-3770.0.2020.094 ZHENG Chaopan, ZENG Xiaoyan, ZHANG Bo, et al. Clinical analysis of the endonasal transpterygoid approach to the resection of malignant tumors involving the middle skull base of 30 cases[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(6): 42-48. doi:10.6040/j.issn.1673-3770.0.2020.094 [17] Battaglia P, Turri-Zanoni M, Dallan I, et al. Endoscopic endonasal transpterygoid transmaxillary approach to the infratemporal and upper parapharyngeal tumors[J]. Otolaryngol Head Neck Surg, 2014, 150(4): 696-702. doi:10.1177/0194599813520290 [18] 刘全, 刘娟, 王欢, 等. 内镜经翼突及上颌窦前壁上咽旁间隙的解剖[J]. 解剖学报, 2021, 52(6): 940-944. doi:10.16098/j.issn.0529-1356.2021.06.016 LIU Quan, LIU Juan, WANG Huan, et al. Endoscopic transpterygoid transmaxillary approach to the upper parapharyngeal space[J]. Acta Anatomica Sinica, 2021, 52(6): 940-944. doi:10.16098/j.issn.0529-1356.2021.06.016 [19] 刘卫卫, 王晓敏, 蔡常琦, 等. 内镜下经鼻-翼突入路切除翼突周围颅底病变的临床分析[J]. 中国耳鼻咽喉颅底外科杂志, 2020, 26(2): 135-138. doi:10.11798/j.issn.1007-1520.202002006 [20] 周兵, 韩德民, 崔顺九, 等. 蝶窦外侧隐窝脑膜脑膨出鼻内镜下经翼突径路手术[J]. 中华耳鼻咽喉头颈外科杂志, 2007, 42(5): 328-333. doi: 10.3760/j.issn: 1673-0860.2007.05.004 ZHOU Bing, HAN Demin, CUI Shunjiu, et al. Endoscopic transpterygoid intervention of meningoencephalocele within lateral recess of sphenoid sinus[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2007, 42(5): 328-333. doi: 10.3760/j.issn: 1673-0860.2007.05.004 [21] 刘全, 孙希才, 于华鹏, 等. 鼻内镜下鼻咽癌切除术的手术分型[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 39-45. doi: 10.6040/j.issn.1673-3770.1.2019.016 LIU Quan, SUN Xicai, YU Huapeng, et al. Types of endoscopic transnasal nasopharyngectomy for nasopharyngeal carcinoma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 39-45. doi: 10.6040/j.issn.1673-3770.1.2019.016 [22] 姜彦. 鼻内镜下经鼻翼突径路旁中线颅底手术[J]. 山东大学耳鼻喉眼学报, 2017, 31(2): 16-24. doi: 10.6040/j.issn.1673-3770.0.2017.115 JIANG Yan. The endoscopic endonasal transpterygoid approach in lateral midline skull base[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2017, 31(2): 16-24. doi: 10.6040/j.issn.1673-3770.0.2017.115 |
[1] | 李红金,王剑,来育斌,许敏,薛涛,陈福权,查定军,陈晓栋. 不同术式治疗上颌骨囊肿的疗效评价[J]. 山东大学耳鼻喉眼学报, 2024, 38(3): 33-37. |
[2] | 刘家欣,姜叶,宋道亮. 鼻内镜下经鼻开窗术治疗上颌骨囊肿9例并文献复习[J]. 山东大学耳鼻喉眼学报, 2024, 38(2): 84-88. |
[3] | 鲁欢,何本超,廖红明. 儿童急性鼻窦炎合并眶眼蜂窝织炎并发颅内感染1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2024, 38(1): 46-50. |
[4] | 徐宏鸣,范文焱,浦诗磊,李晓艳. 儿童上颌窦后鼻孔息肉36例临床资料分析[J]. 山东大学耳鼻喉眼学报, 2023, 37(6): 159-163. |
[5] | 刘楠,逄明杰. 鼻内镜泪囊鼻腔吻合术预后影响因素的研究进展[J]. 山东大学耳鼻喉眼学报, 2023, 37(5): 149-155. |
[6] | 吕萍,李丹丹,宋伟,洪流. 鼻内镜辅助下鼻泪道再通术治疗新生儿期泪囊炎[J]. 山东大学耳鼻喉眼学报, 2023, 37(2): 71-74. |
[7] | 李定波,唐志元,邓智毅,曾宪海,张秋航,王再兴. 低温等离子射频消融术治疗药物性鼻炎27例[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 11-17. |
[8] | 资昊坤,肖旭平,李云秋. 口服糖皮质激素在慢性鼻窦炎伴鼻息肉围手术期的应用现状[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 98-103. |
[9] | 曹轩,肖旭平,李云秋. 透明质酸在慢性鼻窦炎中的研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 104-109. |
[10] | 秦铭,孙占伟,王卫卫,李世超,武天义,王广科. 咽喉反流症状或体征评分阳性的慢性鼻窦炎患者鼻内镜术后碱性等渗盐水冲洗的疗效观察[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 147-153. |
[11] | 陈世琴,卫平存,胡云龙,胡金旺. 糖皮质激素三种不同鼻用法对鼻内镜术后黏膜转归的影响[J]. 山东大学耳鼻喉眼学报, 2022, 36(3): 195-201. |
[12] | 陈坤,陆慧,黄琦,李磊,孟国珍,杨军,侯东明. 小儿先天性鼻腔鼻窦肿物的临床诊疗观察[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 81-85. |
[13] | 芦晓妍, 温树信. 先天性后鼻孔闭锁的治疗进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(1): 138-142. |
[14] | 张旻, 刘永亮, 宋道亮, 韩学锋, 封新荣, 赵允沛. 鼻内镜下改良下鼻甲成形术与下鼻甲低温等离子消融加骨折外移术治疗重度慢性肥厚性鼻炎的临床对比研究[J]. 山东大学耳鼻喉眼学报, 2021, 35(6): 83-88. |
[15] | 巴广益,茆松,孙汐文,唐如,李志鹏,林海,张维天. Voxel-man ENT手术模拟系统在鼻科技能教学中的应用[J]. 山东大学耳鼻喉眼学报, 2021, 35(5): 56-61. |
|