两种入路摘除咽旁间隙肿瘤临床研究

摘要

Objective To compare the curative effect difference between the endoscopy -assisted transoral approach and the transcervi-cal approach of surgical treatment of parapharyngeal space tumors , and to analyze the indication , advantages and surgical skills of the en-doscopy -assisted transoral approach .Methods Retrospective analysis was carried out in 23 patients with parapharyngeal space tumor treated in Shenzhen No.2 People′s Hospital from January , 2012 to June, 2015.23 patients were divided into the observation group and the control group according to the tumors location , and the relationship between PPS neoplasm and adjacent structures .In the observation group, the tumors of 7 cases were removed solely by transoral approach under the guidance of endoscopes , while in the control group , the neoplasms of 16 patients were excised completely through using a transcervical approach .The operation time, blood loss, hospitalization time between the two groups were compared .Results In the observation group , the operation time , the blood loss and the hospitalization time were (127.00 ±9.08 ) minutes, (86.00 ±12.94 ) milliliter, (5.80 ±0.84 ) days respectively.While in the control group , the opera-tion time, the blood loss and the hospitalized time were (128.00 ±11.46)minutes, (235.67 ±15.80) milliliter, (9.07 ±0.88) days respectively. All the neoplasms were completely cut .Patients were followed up for 6 months to 3 years with no recurrence .Through comparing the opera-tion time between the two groups , there was no significant difference .The differences in blood loss , hospitalized time had statistical signifi-cance ( P<0.05 ) between the two groups .Conclusion The endoscopy-assisted transoral approach has significantly shorter hospitaliza-tion time and less blood loss than the transcervical approach .One of the biggest advantages of the endoscopy -assisted transoral approach is the ability to maintain facial cosmetic .The endoscopy-assisted transoral approach is a useful technique for the removal of tumors located anteromedially to the carotid sheath .%目的：比较内镜辅助口内入路与颈部入路摘除咽旁间隙肿瘤的疗效，探讨内镜辅助口内入路的适应症、优点和手术技巧。方法回顾性分析深圳市第二人民医院耳鼻咽喉科2012－01—2015－06间收治的23例咽旁间隙肿瘤患者病历资料，根据肿瘤的位置、肿瘤与周围重要结构的关系，分成观察组7例（采用内镜辅助口内入路）和对照组16例（采用经颈部入路）。比较两组患者的手术时间、术中出血量、住院时间，并行统计学分析。结果观察组手术时间（127．00±9．08） min，术中出血（86．00±12．94）mL，住院时间（5．80±0．84）d；对照组手术时间（128．00±11．46）min，术中出血（235．67±15．80）mL，住院时间（9．07±0．88） d。两组患者肿瘤均完全切除，均未出现严重并发症，所有患者术后随访0．5～3年均无复发。观察组与对照组手术时间差异无统计学意义（ P＞0．05）；术中出血量、住院时间差异有统计学意义（ P＜0．05）。结论内镜辅助口内入路较颈部入路在减少术中出血、缩短住院时间方面有明显优势。内镜辅助口内入路最大的优点是能保存颜面部美观，适用于位于颈动脉鞘内侧及前内侧良性肿瘤的摘除。