内镜下经口入路保留扁桃体茎突截短术疗效分析

doi:10.6040/j.issn.1673-3770.0.2020.413

摘要/Abstract

摘要： 目的探讨经口入路内镜辅助下保留扁桃体茎突截短术的手术方法及临床疗效。方法回顾性分析36例(65侧)茎突综合征患者的临床资料,分析其主诉、病程、误诊情况、茎突长度、扁桃体肿大程度、手术时间、出血量、术后效果,记录患者手术前后的症状改善情况。结果 36例患者中单侧茎突过长7例,双侧茎突过长29例,共65侧茎突。其中主诉为咽异物感27例,颈肩部疼痛不适12例,咽痛及吞咽痛11例,咽干、咳嗽7例,耳部疼痛3例,面部疼痛1例。病程为20 d~3年不等,平均10个月。被误诊为咽炎20例、胃食管返流4例、甲状腺疾病2例、颈椎病1例、上呼吸道感染1例,误诊率为77.8%。36例患者中扁桃体无肿大14例、Ⅰ度肿大20例、Ⅱ度肿大2例,均无慢性扁桃体炎及扁桃体肿物病史。术前茎突长度为(4.38±0.78)cm,其中最长的为7.89 cm,截短茎突的长度为(2.09±0.93)cm。手术时间(67.08±28.4)min,出血量(8.42±5.58)mL。其中6例患者7侧茎突因位置较深或分离困难行骨折外移。术后随访3个月以上,其中症状消失者27例,症状减轻者4例,症状无变化者4例,失访1例。结论经口入路内镜下保留扁桃体茎突截短术保留了正常的扁桃体,手术创伤小、术后疼痛较轻、恢复快、出血少、手术效果好,是治疗茎突综合征有效、安全、微创的手术方式。

关键词: 内镜辅助, 保留扁桃体, 茎突综合征, 茎突过长, 经口茎突截短术

Abstract: Objective To investigate the surgical methods and clinical effects of tonsil-sparing styloid process truncation assisted by endoscopy via an oral approach. Methods We retrospectively analyzed the clinical data of 36 patients with styloid process syndrome(65 sides), the data included the main complaints, course of disease, misdiagnosis, length of the styloid process, and the degree of tonsil enlargement. Results Among the 36 patients, 7 had a unilateral styloid process, 29 had bilateral styloid processes, and 65 had styloid processes. The main complaints were pharyngeal foreign body sensation in 27, neck and shoulder pain or discomfort in 12, sore throat and pain associated with swallowing in 11, dry throat and cough in 7, facial pain in 1, and ear pain in 3 patients. The duration of illness ranged from 20 days to 3 years, with an average of 10 months. Of the misdiagnoses, twenty were pharyngitis, four were gastroesophageal reflux, two were thyroid disease, one was cervical spondylosis, and one was upper respiratory tract infection. The misdiagnosis ratio was 77.8%. Among the 36 patients, 14 had no tonsil hypertrophy, 20 had first-degree enlargement, and 2 had second-degree enlargement. None of the patients had a history of chronic tonsillitis or a tonsil mass. The average length of the preoperative styloid process is(4.38±0.78)cm; the longest is 7.89cm. The average length of the truncated styloid process is(2.09±0.93)cm. The duration of surgery was(67.08±28.4)min, and the blood loss during surgery was(8.42±5.58)mL. In six patients, seven side styloid processes were fractured externally due to the deep position or difficulty of separation. After postoperative follow-up for more than 3 months, 27 cases had resolved symptoms, 4 cases had symptom relief, 4 cases had no change in symptoms. One case was lost to follow-up. Conclusion Tonsil-sparing styloidectomy assisted by the endoscopic transoral approach preserves normal tonsils, with less surgical trauma, less pain, faster recovery, less bleeding, and good surgical results. It is effective for treating styloid process syndrome, which is a safe and minimally invasive surgical method.

Key words: Endoscopy-assisted, Without tonsillectomy, Styloid process syndrome, Eagle syndrome, Intraoral removal of the elongated styloid process

中图分类号:

R766

王学昌, 王涛, 任欣, 赵明俊. 内镜下经口入路保留扁桃体茎突截短术疗效分析[J]. 山东大学耳鼻喉眼学报, 2021, 35(4): 17-21.

WANG Xuechang, WANG Tao, REN Xin, ZHAO Mingjun. Analysis of the clinical efficacy of endoscopy-assisted intraoral removal of an elongated styloid process without tonsillectomy[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(4): 17-21.

参考文献

[1] Eagle WW. Elongated Styloid Processes: report of two cases[J]. Arch Otolaryngol-Head Neck Surg, 1937, 25(5): 584-587. doi:10.1001/archotol.1937.00650010656008.
[2] 张庆泉, 迟作强. 茎突综合征的诊断和治疗[J]. 中华耳鼻咽喉头颈外科杂志, 2009, 44(3): 262-264. doi:10.3760/cma.j.issn.1673-0860.2009.03.022. ZHANG Qingquan, CHI Zuoqiang. Dignosis and treatment of syndrome of styloid process[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2009, 44(3): 262-264. doi:10.3760/cma.j.issn.1673-0860.2009.03.022.
[3] Eagle WW. Elongated styloid process: symptoms and treatment[J]. Arch Otolaryngol-Head Neck Surg, 1958, 67(2): 172-176. doi:10.1001/archotol.1958.00730010178007.
[4] Costantinides F, Della Flora F, Tonni I, et al. Elongation of the styloid processes in kidney-transplanted patients: The role of ectopic calcification as possible cause of Eagle syndrome[J]. Cranio, 2019: 1-5. doi:10.1080/08869634.2019.1640919.
[5] Zamboni P, Scerrati A, Menegatti E, et al. The eagle jugular syndrome[J]. BMC Neurol, 2019, 19: 333. doi:10.1186/s12883-019-1572-3.
[6] Bai C, Wang Z, Guan J, et al. Clinical characteristics and neuroimaging findings in eagle syndrome induced internal jugular vein Stenosis[J]. Ann Transl Med, 2020, 8(4): 97. doi:10.21037/atm.2019.12.93.
[7] Torikoshi S, Yamao Y, Ogino E, et al. A staged therapy for internal carotid artery dissection caused by vascular eagle syndrome[J]. World Neurosurg, 2019, 129: 133-139. doi:10.1016/j.wneu.2019.05.208.
[8] Ikenouchi H, Takagi M, Nishimura A, et al. Bilateral carotid artery dissection due to Eagle syndrome in a patient with vascular Ehlers-Danlos syndrome: a case report[J]. BMC Neurol, 2020, 20(1): 285. doi:10.1186/s12883-020-01866-2.
[9] Badhey A, Jategaonkar A, Anglin Kovacs AJ, et al. Eagle syndrome: a comprehensive review[J]. Clin Neurol Neurosurg, 2017, 159: 34-38. doi:10.1016/j.clineuro.2017.04.021.
[10] Lee YW, Chung J. Eagle syndrome after a fracture of complete ossified stylohyoid ligament from indirect trauma treated using local steroid injection: a case report[J]. Medicine(Madr), 2020, 99(25): e20818. doi:10.1097/md.0000000000020818.
[11] Fitzpatrick TH IV, Lovin BD, Magister MJ, et al. Surgical management of Eagle syndrome: a 17-year experience with open and transoral robotic styloidectomy[J]. Am J Otolaryngol, 2020, 41(2): 102324. doi:10.1016/j.amjoto.2019.102324.
[12] Montevecchi F, Caranti A, Cammaroto G, et al. Transoral robotic surgery(TORS)for bilateral eagle syndrome[J]. ORL J Otorhinolaryngol Relat Spec, 2019, 81(1): 36-40. doi:10.1159/000493736.
[13] 黄纪逸, 李柏滋, 吴树浓, 等. 咽腭弓肌黏膜瓣闭合扁桃体等离子术后创面的临床疗效[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 92-95. doi: 10.6040/j.issn.1673-3770.0.2018.400. HUANG Jiyi, LI Baizi, WU Shunong, et al. Clinical efficacy of the pharyngopalatine arch muscle mucosal flap for tonsillectomy wound closure after plasma surgery[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(4): 92-95. doi: 10.6040/j.issn.1673-3770.0.2018.400.
[14] 仇继兵, 尹燕泽, 马敬. 茎突截短术改善茎突综合征咽痛症状八例[J]. 山东大学耳鼻喉眼学报, 2017, 31(6): 71-73. doi:10.6040/j.issn.1673-3770.1.2017.224. QIU Jibing, YIN Yanze, MA Jing. Improvement of pharyngalgia in 8 cases of styloid process syndrome by surgical shortening of the styloid proces- ses[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2017, 31(6): 71-73. doi:10.6040/j.issn.1673-3770.1.2017.224.
[15] 金德斌, 杨长东, 白文忠, 等. 保留扁桃体的茎突截短术[J]. 华西医学, 2013, 28(2): 256-258. doi:10.7507/1002-0179.20130080.
[16] Czako L, Hirjak D, Simko K, et al. 3D navigation in surgery of Eagle syndrome[J]. Bratisl Lek Listy, 2019, 120(7): 494-497. doi:10.4149/bll_2019_078.
[17] 滕冬梅, 李春花, 邓磊, 等. 医护四手操作模式与单手操作模式在结直肠息肉内镜下切除术中的临床比较[J]. 检验医学与临床, 2019, 16(2): 234-236. doi:10.3969/j.issn.1672-9455.2019.02.029.
[18] Caylakli F. Important factor for pain relief in patients with eagle syndrome: Excision technique of styloid process[J]. Am J Otolaryngol, 2019, 40(2): 337. doi:10.1016/j.amjoto.2018.10.009.
[19] Ayyildiz VA, Senel FA, Dursun A, et al. Morphometric examination of the styloid process by 3D-CT in patients with Eagle syndrome[J]. Eur Arch Otorhinolaryngol, 2019, 276(12): 3453-3459. doi:10.1007/s00405-019-05602-6.
[20] 倪伟, 鲁海涛, 万俐佳. 鼻内镜在茎突过长手术中的临床应用[J]. 临床耳鼻咽喉头颈外科杂志, 2014, 28(11): 805-807. doi:10.13201/j.issn.1001-1781.2014.11.014. NI Wei, LU Haitao, WAN Lijia. Application of nasal endoscopy in styloid process truncating operation[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2014, 28(11): 805-807. doi:10.13201/j.issn.1001-1781.2014.11.014.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed