Abstract:

 Objective　To investigate how to choose a reasonable surgical approach according to the clinical characteristics and imaging manifestations of paropharyngeal space tumors. Methods　Eighteen patients with parapharyngeal space tumors treated at Guangzhou Panyu Central Hospital from January 2012 to June 2022 were retroretrospectively analyzed. There were 10 males and 8 females. They were 20-64 years old, with an average of 44. They were surgically treated through different approaches according to the results of preoperative CT and (or) MRI and clinical characteristics. Results　Fourteen cases were operated through the lateral transcervical approach, ２cases through the transparotid approach, 1 case through the transoral approach, and 1 case through the transoral and lateral transcervical approaches. Postoperative pathological diagnosis confirmed that there were 8 cases of pleomorphic adenoma, 8 cases of neurilemmoma, 1 case of adenolymphoma, and 1 case of parotid ductal carcinoma. After surgery, 3 cases got voice hoarseness. Seventeen cases of benign tumors were followed up and had no recurrence for 4 months to 10 years. One case of parotid ductal carcinoma was treated with radiotherapy after surgery and followed up for 26 months, with no tumor recurrence or metastasis. Conclusions　The lateral transcervical approach is the most commonly surgical method for parapharyngeal space tumors. Benign tumors have the main bodies protruding toward the oropharynx and locate in the medial of internal carotid; the transoral approach is a choice for them. The choice of a large pleomorphic adenoma derived from the deep lobe of the parotid gland through the transoral approach and transparotid approach is obviously better than through the lateral transcervical approach alone. Extracapsula resection of neurilemmoma is easy to damage the vagus nerve and get hoarseness.

Key words:

Neoplasm, Parapharyngeal space, Imaging, Surgical approaches, Intracapsula enucleation

摘要：

目的　探讨如何根据咽旁间隙肿瘤的临床特征、影像学表现，选择治疗咽旁间隙肿瘤的合理手术径路。方法　回顾性分析2012年1月至2022年6月广州市番禺中心医院收治的18例咽旁间隙肿瘤患者，男10例，女8例，年龄20～64岁，平均44岁，根据术前CT和（或）MRI检查结果结合临床特征接受不同径路的手术治疗。结果　经颈侧径路14例，经腮腺径路2例，经口径路1例，经口联合颈侧径路1例。术后病理诊断多形性腺瘤8例，神经鞘膜瘤8例，腺淋巴瘤和腮腺导管癌各1例。术后并发声嘶3例。17例良性肿瘤术后随访4个月到10年均无复发，1例腮腺导管癌术后加放疗、随访26个月无复发。结论　颈侧径路是咽旁间隙肿瘤最常用的手术方法。良性肿瘤主体凸向口咽，位于颈内动脉内侧可选择经口径路手术，来源于腮腺深叶的巨大多形性腺瘤选择腮腺联合经口径路显然优于单纯颈外进路。神经鞘瘤囊外切除容易损伤迷走神经而出现声嘶。

关键词:

肿瘤, 咽旁间隙, 影像学, 手术径路, 囊内切除