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目的:探讨咽旁间隙肿瘤的诊断及手术入路的合理选择。方法:对45例咽旁间隙肿瘤患者的资料进行回顾性分析。患者均行CT及颈部彩超检查,部分患者行MRI或DSA检查。采用的手术入路分别为:颈侧切开入路35例,腮腺入路5例,颈颌入路2例,颞骨加腮腺入路3例。结果:45例患者中良、恶性肿瘤分别为37例(82.22%)和8例(17.78%),其中以神经源性及涎腺来源最为常见。应用CT、MRI和DSA明确肿瘤的位置、大小、形态、密度、强化程度及肿瘤与茎突和颈动脉的关系,作出术前诊断,其与术后病理诊断的符合率为80%(组织来源符合率)。37例良性肿瘤完整切除,1例淋巴管瘤术后1年复发,再次手术后无复发。8例恶性肿瘤中,2例为恶性混合瘤,1例随诊4年无复发,1例随诊3年,带瘤生存;2例滑膜肉瘤,1例随诊3年无复发,1例随诊2年无复发;1例鼻咽癌咽旁间隙转移,术后给予根治性放疗,随诊5年无复发;1例脊索瘤随诊3年,复发带瘤生存;1例低分化鳞状细胞癌随诊4年,死于肺转移;1例滤泡树突状细胞肉瘤随诊2年无复发;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。颈侧切开入路简便、安全、创伤小,是咽旁间隙肿瘤手术的最佳入路。
Objective: To explore the diagnosis of parapharyngeal space tumor and the reasonable choice of surgical approach. Methods: The data of 45 patients with parapharyngeal space tumor were analyzed retrospectively. Patients underwent CT and neck color Doppler ultrasound examination, some patients underwent MRI or DSA examination. The surgical approaches were: 35 cases of incision on the neck side, 5 cases of parotid approach, 2 cases of cervical approach and 3 cases of temporal parotid and parotid approach. Results: Among the 45 patients, 37 cases (82.22%) were malignant tumors and 8 cases (17.78%) were malignant tumors. Neurogenic and salivary gland originated most frequently from 45 patients. The location, size, shape, density, degree of enhancement and the relationship between tumor and styloid process and carotid artery were determined by CT, MRI and DSA, and the preoperative diagnosis was made. The coincidence rate with pathological diagnosis was 80% (tissue source Coincidence rate). Thirty-seven patients had complete resection of benign tumor, one case of lymphangioma recurred one year after operation and no recurrence after operation. Of the 8 malignant tumors, 2 were malignant mixed tumors. One case was followed up for 4 years without recurrence. One case was followed up for 3 years with tumor survival. Two cases had synovial sarcoma. One case had no recurrence in 3 years and 1 case Follow-up 2 years without recurrence; 1 case of pharyngeal space metastasis of nasopharyngeal carcinoma, postoperative radical radiotherapy, 5-year follow-up no recurrence; 1 case of chordoma followed up for 3 years, recurrence with tumor survival; 1 case of poorly differentiated squamous cell carcinoma The diagnosis of squamous cell carcinoma of the parapharyngeal space was of great significance in the diagnosis and differential diagnosis of parapharyngeal space tumors. One case of follicular dendritic cell sarcoma had no recurrence after 2 years follow-up. The neck side of the open access is simple, safe, small trauma, parapharyngeal space tumor surgery is the best way.