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

doi:10.6040/j.issn.1673-3770.1.2020.086

摘要/Abstract

摘要： 目的探讨低温等离子射频消融技术应用于咽旁间隙良性肿瘤切除中的可操作性及疗效。方法回顾分析咽旁间隙良性肿瘤患者20例病历资料,术中应用低温等离子手术设备11例作为A组,未使用低温等离子9例作为B组。充分评估所有患者手术适应证,详细记录临床资料、术式选择、术中过程、病理结果及术后疗效。结果 20例中以神经源性肿瘤居多(13/20例),其次为多形性腺瘤(4/20例)。A组手术方式以经口、经鼻等内侧径路为主(6/11例),B组全部为外侧径路。两组均有不同程度的并发症出现, B组1例复发。结论咽旁间隙肿瘤手术趋于安全、微创,根据肿瘤的位置、性质可选择不同的手术径路。低温等离子在经口、鼻等内侧径路咽旁间隙肿瘤手术中起到重要的作用。

关键词: 咽旁间隙, 头颈部肿瘤, 低温等离子, 外科手术, 手术入路

Abstract: Objective To evaluate the feasibility and effect of low-temperature plasma radiofrequency ablation(LTPRA)in the operation of benign tumors in the parapharyngeal space(PPS). Methods Twenty patients with benign tumors in the PPS who underwent surgery in our hospital from January 2012 to December 2018 were analyzed. Of the 20 patients, 11(group A)were treated with LTPRA and 9(group B)without LTPRA. All the patients were thoroughly evaluated before surgery. The clinical data, pathological results, and surgical information of patients were collected. Results In this study, neurogenic tumors were the most common benign tumors in the PPS(13 cases). Six patients in group A(of 11 cases)underwent the transoral or transnasal surgical approaches. In group B, all nine patients underwent lateral approaches. Surgical complications occurred in both groups. One recurrent case was observed from group B. Conclusion Surgery for PPS tumors tends to be safe and minimally invasive. Different surgical approaches can be selected according to the location and character of the tumor. LTPRA plays an important role in the operation of PPS tumors in transoral and transnasal approaches.

Key words: Parapharyngeal space, Head and neck tumors, Low-temperature plasma, Surgery, Surgical approach

中图分类号:

R739.63

朱华明,关建,茆松,张维天,易红良. 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.

ZHU Huaming, GUAN Jian, MAO Song, ZHANG Weitian, YI Hongliang. 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.

参考文献

[1] 胡娟娟, 洪育明. 咽旁间隙肿瘤的诊断和治疗[J]. 山东大学耳鼻喉眼学报, 2014(5): 85-90. doi:10.6040/j.issn.1673-3770.0.2014.159. HU Juanjuan, HONG Yuming. Diagnosis and treatment of parapharyngeal space neoplasms[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2014(5): 85-90. doi:10.6040/j.issn.1673-3770.0.2014.159.
[2] Kuet ML, Kasbekar AV, Masterson L, et al. Management of tumors arising from the parapharyngeal space: a systematic review of 1, 293 cases reported over 25 years[J]. Laryngoscope, 2015, 125(6): 1372-1381. doi:10.1002/lary.25077.
[3] Liu XW, Wang L, Li H, et al. A modified method for locating parapharyngeal space neoplasms on magnetic resonance images: implications for differential diagnosis[J]. Chin J Cancer, 2014, 33(10): 511-520. doi:10.5732/cjc.014.10017.
[4] Basaran B, Polat B, Unsaler S, et al. Parapharyngeal space tumours: the efficiency of a transcervical approach without mandibulotomy through review of 44 cases[J]. Acta Otorhinolaryngol Ital, 2014, 34(5): 310-316.
[5] Shinohara Y, Matsumoto T, Kiga N, et al. Neurilemmoma of the Vagus Nerve in the Poststyloid Parapharyngeal Space[J]. J Clin Diagn Res, 2016, 10(1):17-19. doi: 10.7860/JCDR/2016/13789.7141.
[6] Luna-Ortiz K, Villa-Zepeda O, Carrillo JF, et al. Parapharyngeal space tumor: submandibular approach without mandibulotomy[J]. J Maxillofac Oral Surg, 2018, 17(4): 616-624. doi:10.1007/s12663-018-1133-0.
[7] 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.
[8] Pradhan P, Preetam C, Parida PK, et al. Surgical management of parapharyngeal space tumours in a single tertiary care center[J]. Indian J Otolaryngol Head Neck Surg, 2018, 70(4): 531-537. doi:10.1007/s12070-018-1447-8.
[9] 刘方舟,董明敏,张园,等. 咽旁间隙原发肿瘤69例临床病理与解剖分析[J]. 临床耳鼻咽喉头颈外科杂志, 2009, 23(3): 113-114, 118. doi:10.3969/j.issn.1001-1781.2009.03.005. LIU Fangzhou, DONG Mingmin, ZHANG Yuan, et al. Clinical pathology and anatomy features of parapharyngeal region neoplasms: a report of 69 cases[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2009, 23(3): 113-114, 118. doi:10.3969/j.issn.1001-1781.2009.03.005.
[10] Ijichi K, Murakami S. Surgical treatment of parapharyngeal space tumors: a report of 29 cases[J]. Oncol Lett, 2017, 14(3): 3249-3254. doi:10.3892/ol.2017.6480.
[11] 吕洁瑜, 何炽辉, 周洽锋, 等. 鼻内镜下咽旁间隙解剖研究[J]. 中国耳鼻咽喉颅底外科杂志, 2014, 20(2): 149-151. doi:10.11798/j.issn.1007-1520.201402017. LV Jieyu, HE Zhihui, ZHOU Qiafeng, et al. Endoscopic anatomical study of parapharyngeal space[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2014, 20(2): 149-151. doi:10.11798/j.issn.1007-1520.201402017.
[12] 任昱. 颈动脉损伤诊断与治疗进展[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 105-109. doi:10.6040/j.issn.1673-3770.0.2019.358. REN Yu. Advances in the diagnosis and treatment of carotid artery injuries[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 105-109. doi:10.6040/j.issn.1673-3770.0.2019.358.
[13] 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.
[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] 罗兴谷, 卢永田, 王晓彬. 内镜下经口径路咽旁间隙肿瘤摘除5例[J]. 山东大学耳鼻喉眼学报, 2014, 28(4): 56-58. LUO Xinggu, LU Yongtian, WANG Xiaobin. Surgical treatment of parapharyngeal space tumors via endoscopic transoral approach: a retrospective analyses of 5 cases[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2014, 28(4): 56-58.
[16] 张宝莹, 卢永田, 李建兴. 口内径路咽旁间隙的内镜解剖结构[J]. 山东大学耳鼻喉眼学报, 2015, 29(4): 38-41. ZHANG Baoying, LU Yongtian, LI Jianxing. Transoral endoscopic dissection of parapharyngeal space[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2015, 29(4): 38-41.
[17] Markou K, Blioskas S, Krommydas A, et al. Transoral resection of giant parapharyngeal space tumors via a combined surgical approach[J]. Iran J Otorhinolaryngol, 2019, 31(103): 87-96.
[18] 邓月, 程寅, 徐亚平, 等. 内镜下低温等离子射频消融切除高位咽旁间隙肿瘤的临床疗效分析[J]. 中国耳鼻咽喉颅底外科杂志, 2019, 25(1): 69-72. doi:10.11798/j.issn.1007-1520.201901014. DENG Yue, CHENG Yin, XU Yaping, et al. Clinical analysis of endoscopic low-temperature plasma radiofrequency ablation for tumors in superior parapharyngeal space[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2019, 25(1): 69-72. doi:10.11798/j.issn.1007-1520.201901014.
[19] 李树华, 石洪金, 吴大海. 经口径路切除巨大咽旁间隙良性肿瘤[J]. 中华耳鼻咽喉头颈外科杂志, 2014, 49(10): 844-847. doi:10.3760/cma.j.issn.1673-0860.2014.10.011. LI Shuhua, SHI Hongjin, WU Dahai. Resection of macrosis benign parapharyngeal neoplasms via oral approach[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2014, 49(10): 844-847. doi:10.3760/cma.j.issn.1673-0860.2014.10.011.
[20] 侯佳欣,王玲,胡国华. 咽旁间隙肿瘤手术径路及其应用解剖[J]. 中华解剖与临床杂志, 2020,25(1):88-92. doi:10.3760/cma.j.issn.2095-7041.2020.01.016. HOU Jiaxin,WANG Ling,HU Guohua.Surgical approach and applied anatomy of parapharyngeal space tumors[J]. Chinese Journal of Anatomy and Clinics, 2020,25(1):88-92.doi:10.3760/cma.j.issn.2095-7041.2020.01.016.

相关文章 15

[1]	陈涛,姜洋,李莹. SMILE矫正PRK术后屈光回退1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 148-153.
[2]	杨鸣,刘雪霞,张华. m6A识别蛋白IGF2BPs家族在头颈肿瘤中的研究进展[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 153-161.
[3]	黄佳丽,刘梓琪,徐娟,陈曦,张立庆,周涵. 咽部梭形细胞鳞状细胞癌的临床及预后分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 94-100.
[4]	后婕,刘丁丁,王涵东,徐峥嵘,钱晓云,高下,俞晨杰. 鼻内镜下经泪前隐窝-翼突入路上咽旁间隙病变手术[J]. 山东大学耳鼻喉眼学报, 2024, 38(4): 28-35.
[5]	张静祎,董湘依,牟亚魁,宋西成. 细胞焦亡在耳鼻咽喉科疾病中的研究进展[J]. 山东大学耳鼻喉眼学报, 2024, 38(4): 140-148.
[6]	任晓勇. 阻塞性睡眠呼吸暂停合并症的研究现状和未来展望[J]. 山东大学耳鼻喉眼学报, 2023, 37(6): 1-5.
[7]	徐聪,卢国伟,吕永斌,刘大炜,宋西成,孙岩. 扁桃体周围脓肿切开术后引发颅内积气1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2023, 37(5): 63-67.
[8]	佘志强,刘继远. 不典型喉旁间隙异物1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2023, 37(3): 60-63.
[9]	彭薪燃,李永团. Madelung病伴阴囊脂肪堆积1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2023, 37(3): 67-71.
[10]	陈明浩,张秋航,侯佳蒙,田秀芬. 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.
[11]	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.
[12]	朱晶,张睿,赵媛,李炀,樊孟耘,赵昱. 内镜下低温等离子消融治疗不同炎症分期先天性梨状窝瘘45例[J]. 山东大学耳鼻喉眼学报, 2022, 36(5): 24-29.
[13]	朱晶,张睿,赵媛,李炀,赵昱. 新生儿咽旁间隙卡梅现象1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 55-59.
[14]	龚霄阳,李旺,陈曦. 原发性咽旁间隙肿瘤67例回顾性分析[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 60-65.
[15]	李利杰,田秀芬. CO₂激光联合低温等离子治疗早期声门型喉癌40例[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 79-85.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed