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目的:分析咽旁间隙良性肿瘤的影像学特征,总结咽旁间隙良性肿瘤手术入路的选择,尤其是经口进路切除咽旁间隙良性肿瘤的方法。方法:回顾性分析1997-2006年收治的48例咽旁间隙良性肿瘤患者的临床资料,术前全部行CT增强扫描,部分行MRI扫描。全部手术治疗,经口进路16例(33.3%),单纯颈侧进路19例(39.6%),颈侧腮腺进路13例(27.1%)。结果:CT和MRI能很好地显示肿瘤的部位、形状、大小、范围及可能的病理性质。术后3年内复发2例。经口进路术后发生霍纳氏征1例,术腔血肿形成1例。颈侧进路发生暂时性面瘫5例,副神经麻痹1例。结论:CT和MRI扫描能区分咽旁肿瘤位于茎突前或茎突后间隙以及和邻近组织的关系,手术入路应根据肿瘤的大小、位置和重要血管之间的关系来选择。部分咽旁间隙良性肿瘤经口进路切除安全可行,与颈侧进路比较并不增加手术的危险性和术后复发率,符合微创美观的原则。
OBJECTIVE: To analyze the imaging features of benign parapharyngeal space and to summarize the choice of surgical approach to benign parapharyngeal space, especially the method of resection of benign parapharyngeal space by oral approach. Methods: The clinical data of 48 patients with benign parapharyngeal space admitted to our hospital from 1997 to 2006 were analyzed retrospectively. All the patients underwent preoperative CT contrast enhanced CT scan and partial MRI scan. All surgeries included 16 cases (33.3%) with oral approach, 19 cases (39.6%) with simple neck lateral approach and 13 cases (27.1%) with parotid gland approach. Results: CT and MRI can show the location, shape, size, range and possible pathological features of the tumor well. 2 cases relapsed within 3 years after operation. One case of Horner ’s syndrome occurred after oral approach, and one case developed hematoma of the cavity. Lateral neck approach occurred in 5 cases of temporary facial paralysis, paraplegia in 1 case. Conclusion: CT and MRI can distinguish the relationship between the parapharyngeal tumor located in the anterior or posterior styloid process and the adjacent tissue. Surgical approach should be based on the tumor size, location and the relationship between the important blood vessels. Partial parapharyngeal space benign tumor removal via oral approach is safe and feasible, compared with the neck approach does not increase the risk of surgery and postoperative recurrence rate, in line with the principle of minimally invasive aesthetics.