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目的:探讨咽旁间隙肿瘤的诊断、治疗与手术入路的选择。方法:回顾性分析112例接受手术治疗的咽旁间隙肿瘤患者的临床资料,包括其临床症状、体征、病理类型、影像学检查、术后并发症及其处理、手术入路的合理选择。结果:CT、MRI和数字减影血管造影(DSA)能明确肿瘤的大小、位置及与周围组织结构的关系;术后组织病理学类型多样,良性肿瘤98例,其中涎腺源性肿瘤52例,神经源性肿瘤33例,其他良性肿瘤13例,随访3年,涎腺多形性腺瘤局部复发3例,神经纤维瘤复发1例,经再次手术治愈;恶性肿瘤14例,其中8例生存5年,2例(腺样囊性癌、癌在多形性腺瘤中)术后2年半肿瘤局部复发,再次手术并辅以术后放疗,随访3年,无再复发,其他4例随访1~3年未见复发;术后周围性面瘫25例,舌下神经麻痹3例,迷走神经损伤1例,Horner综合征2例,Frey综合征4例,腮瘘3例,术腔积液感染1例。结论:CT、MRI和DSA对咽旁间隙肿瘤的诊断与鉴别诊断具有重要意义,熟悉咽旁间隙的解剖结构,给予正确的术前检查与评估,选择恰当的手术径路是治疗咽旁间隙肿瘤的关键。
Objective: To explore the diagnosis, treatment and choice of surgical approach for parapharyngeal space tumor. Methods: The clinical data of 112 patients with parapharyngeal space tumor undergoing surgery were analyzed retrospectively. The clinical data including clinical symptoms, signs, pathological types, imaging examination, postoperative complications, treatment and surgical approach were retrospectively analyzed. Results: CT, MRI and digital subtraction angiography (DSA) can confirm the tumor size, location and the relationship with the surrounding tissue structure; postoperative histopathological types of 98 cases of benign tumors, of which 52 cases of salivary gland tumor , 33 cases of neurogenic tumors and other benign tumors in 13 cases, followed up for 3 years, salivary gland pleomorphic adenoma recurrence in 3 cases, neurofibroma recurrence in 1 case, re-operation cured; Malignant tumors in 14 cases, of which 8 cases survived 5 years, 2 cases (adenoid cystic carcinoma, carcinoma in pleomorphic adenoma) local recurrence 2 years and a half after operation, reoperation and radiotherapy, followed up for 3 years, no recurrence, the other 4 cases were followed up 1 to 3 years without recurrence; 25 cases of peripheral facial paralysis, sublingual nerve paralysis in 3 cases, 1 case of vagus nerve injury, Horner syndrome in 2 cases, Frey syndrome in 4 cases, 3 cases of gills fistula, 1 case. Conclusion: CT, MRI and DSA are important for the diagnosis and differential diagnosis of parapharyngeal space tumors. They are familiar with the anatomic structure of parapharyngeal space and give correct preoperative examination and evaluation. Choosing the appropriate surgical approach is the treatment of parapharyngeal space tumor The essential.