摘要
目的 探讨经泪前隐窝-翼突入路切除上咽旁间隙病变的鼻内镜下手术方法、适应证及临床效果.方法 回顾性总结2016 年 2 月至 2021 年 8 月收治的 10 例上咽旁间隙占位性病变患者在鼻内镜下经泪前隐窝-翼突入路完成手术情况,分析此路径手术运用特点、手术并发症及疗效.结果 所有患者均在鼻内镜下经泪前隐窝-翼突入路顺利暴露肿瘤.10 例中术后病理确诊为海绵状血管瘤 3 例,术后MRI显示均获全切;淋巴瘤 2 例、炎性/炎性假瘤 4 例及鼻咽癌 1 例,术后MRI显示均为次全切除.随访时间 6～28 个月,3 例血管瘤均无复发;2 例淋巴瘤,经化疗均获得完全缓解;4 例炎性/炎性假瘤较术后无明显变化;1 例鼻咽癌放疗后鼻咽部病灶完全缓解.10 例患者术后均出现患侧硬腭麻木的并发症,其中 4 例患者随访时硬腭麻木未有改善.结论 经泪前隐窝-翼突入路可有效显露上咽旁间隙,咽鼓管、腭帆张肌、翼内肌及翼内板,可作为该区域重要的解剖参考标志并利于颅底重要结构的保护.该入路可作为上咽旁间隙病变手术的重要供选方案.
Abstract
Objective In this study,we aimed to evaluate the feasibility of the operative method,indications,and clinical outcomes of the endoscopic prelacrimal recess-transpterygoid approach for treating lesions in the upper parapharyngeal space.Methods We retrospectively analyzed 10 cases of upper parapharyngeal space lesions between February 2016 and August 2021.Enhanced MRI and CT scans were performed before surgery.All the patients underwent endoscopic surgery,during which the pterygoid process was exposed by removing the anterior and medial walls and soft tissues in the pterygopalatine fossa through a prelacrimal-recess approach.Furthermore,using the eustachian tube,musculus palatosalpingeus,medial pterygoid muscle,and lateral pterygoid plate as reference marks,lesions in the upper parapharyngeal space were removed under image-navigation-assisted endoscopic surgery.A week after the surgery,enhanced MRI reinspection was performed to assess the characteristics,complications,and surgical outcomes.Results All patients'lesions were fully exposed by endoscopic prelacrimal-recess-transpterygoid approach.Among the ten cases,three cases of cavernous hemangioma,two cases of lymphoma,four cases of inflammation/inflammatory pseudotumor,and one case of nasopharyngeal carcinoma were confirmed through histopathological and immunohistochemical examination.Among these,all cavernous hemangiomas were totally removed,whereas lymphomas,and inflammation/inflammatory pseudotumors,naso-pharyngeal carcinoma were subtotally removed after surgery.During the post-surgery follow-up period of 6-28 months,all the cases of hemangioma exhibited no recurrence,lymphoma cases exhibited complete remission after chemotherapy,inflammation/inflamma-tory pseudotumor cases exhibited no significant change compared with their post-surgery condition,and nasopharyngeal carcinoma case exhibited complete remission of nasopharyngeal disease after radiotherapy.Additionally,postoperative hard palate numbness on the affected side occurred in all 10 patients,four cases of hard palate numbness exhibited no remission.Conclusion The endoscopic prelacrimal-recess-transpterygoid approach effectively exposed the upper parapharyngeal space.The eustachian tube,musculus pala-tosalpingeus,medial pterygoid muscle,and medial pterygoid plate can be used as anatomical reference marks in this area to facilitate removal of lesions while protecting vital structures of the skull base.This approach is advantageous for the removal of lesions located in the upper parapharyngeal space.
基金项目
国家自然科学基金重大项目(82192862)
南京市卫生科技发展专项资金资助项目(YKK20070)
南京医科大学 2021年度教育研究课题(2021ZC078)
江苏省自然科学基金青年基金项目(CBK2020031)
NETL
NSTL
万方数据