翼腭窝及其毗邻区域肿瘤的手术入路及临床研究

中国临床解剖学杂志 ›› 2013, Vol. 31 ›› Issue (6): 624-626.

翼腭窝及其毗邻区域肿瘤的手术入路及临床研究

廖建春¹，　邓斌华²，　陈进璜³，　胡建道⁴，　李永德⁵，　吕政纲⁶张健⁷，　刘环海¹，　纪振华¹，　彭浒¹，　刘海斌¹

1.第二军医大学附属长征医院耳鼻咽喉-头颈外科，上海 200003； 2.武警江西总队医院耳鼻咽喉-头颈外科，南昌 330030； 3.龙海市第一医院耳鼻咽喉-头颈外科，福建龙海 363100；4.宁波市鄞州人民医院耳鼻咽喉-头颈外科，浙江宁波 315000；5.舟山市普陀人民医院耳鼻咽喉-头颈外科，浙江舟山 316100；6.东阳市人民医院耳鼻咽喉-头颈外科，浙江东阳 322100；7.启东市中医院耳鼻咽喉-头颈外科，江苏启东 226200

收稿日期:2013-08-15 出版日期:2013-11-25 发布日期:2013-12-16
作者简介:廖建春（1963-），男，教授，主任医师，研究生导师，研究方向：耳鼻咽喉颅底外科应用解剖及肿瘤外科，Tel：（021）81885966

A clinical analysis of different approach to tumors in pterygopalatine fossa and its contiguous region

LIAO Jian-chun¹, DENG Bin-hua², CHEN Jin-huang³, HU Jian-dao⁴, LI Yong-de⁵, LV Zheng-gang⁶, ZHANG Jian⁷, LIU Huan-hai¹, JI Zhen-hua¹, PENG Hu¹, LIU Hai-bin¹

1. Department of Otorhinolaryngology - Head and Neck Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China; 2. Department of Otorhinolaryngology - Head and Neck Surgery, Armed Police Hospital of Jiangxi, Nanchang 330030, Jiangxi Provience, China; 3.Department of Otorhinolaryngology - Head NeckSurgery, First Hospital of Longhai, Longhai 363100, Fujian Provience, China; 4.Department of Otorhinolaryngology - Head and Neck Surgery, People's Hospital of Yinzhou, Ningbo315000, Zhejiang Provience, China; 5.Department of Otorhinolaryngology - Head and Neck Surgery, People's Hospital of Putuo, Zhoushan 316100, Zhejiang Provience, China; 6.Department of Otorhinolaryngology - Head and Neck Surgery, People's Hospital of Dongyang, Jinhua 322100, Zhejiang Provience, China; 7. Department of Otorhinolaryngology - Headand Neck Surgery, Qidong Hospital of Traditional Chinese Medicine, Nantong 226200, Jiangsu Provience, China

Received:2013-08-15 Online:2013-11-25 Published:2013-12-16

摘要/Abstract

摘要：

目的　探讨如何选择最佳手术入路切除翼腭窝及其毗邻区域肿瘤，以提高疗效，减少并发症和后遗症。方法　回顾性分析108例翼腭窝及其毗邻区域肿瘤患者的临床表现、组织学诊断、影像学检查及各种手术入路。结果　85例良性肿瘤患者随访0.5～5年，无一例复发；23例恶性肿瘤患者术后均行放化疗，随访0.5～5年，生存期不足1年6例，0.5～4年8例，5年及以上11例。结论　⑴鼻侧切开术行上颌骨部分切除术适合于原发于筛上颌窦侵及翼腭窝及其毗邻区域病变；⑵扩大上颌骨切除术适合于原发上颌窦恶性肿瘤累及翼腭窝及其毗邻区域；⑶面正中揭翻术或鼻内镜辅助下面正中揭翻术适合于鼻腔、鼻窦、鼻咽、翼腭窝的良性肿瘤及生长缓慢的恶性肿瘤侵犯翼腭窝及其毗邻区域；⑷颞-颧-颌联合入路适合于翼腭窝及其毗邻区域肿瘤累及颞下窝及蝶鞍旁；⑸颈颌入路适合于咽旁间隙良、恶性肿瘤侵犯翼腭窝及其毗邻区域；⑹正中下颌骨裂开入路适合于翼腭窝及其毗邻区域肿瘤累及颞下窝、椎前间隙及颅底；⑺经口腔腭部入路适合于鼻咽、翼腭窝的良性肿瘤及生长缓慢的恶性肿瘤侵犯翼腭窝及其毗邻区域。⑻鼻内镜下入路适合于鼻咽、翼腭窝的良性肿瘤及生长缓慢的恶性肿瘤侵犯翼腭窝及其毗邻区域。

关键词: 翼腭窝, 咽旁间隙, 头颈部肿瘤, 外科手术

Abstract:

Objective　To analyze the best approach for treatment of tumors in the pterygopalatine fossa and its contiguous region.　Methods　The data of 108 cases of tumors in the pterygopalatine fossa and its contiguous region were analyzed retrospectively.　Results　In 85 cases of benign tumors with 0.5 to 5 years follow-up, no recurrencewas bserved. In 23 cases of malignant tumors with 0.5 to 5 years follow-up, survival times after radiotherapy were : less than one year for 6 cases, 1 to 4 years for 8 cases,more than 5 years for 11 cases.　Conclusion (1) Lateral rhinotomy with partial resection of maxilla can be adopted forprimary ethmoid and maxillary sinus tumors. (2) Extended maxillectomy can be adopted for primary maxillary sinus malignant tumors with pterygopalatine fossa or its contiguous region involvement. (3) Midfacial degloving operation issuitable for primary benign or low-grade malignant maxillary sinus t tumors with involvement of the pterygopalatine fossa or its contiguous region. (4) Temporal zygomatic approach can be adopted for tumors in the pterygopalatine fossa or its contiguous region with involvement of the infratemporal fossa (5) Transcervical maxillary approach can beadopted for primary parapharyngeal space tumors with pterygopalatine fossa or its contiguous region involved. (6) Sagittal split ramus osteotomy can be adopted for tumors inpterygopalatine fossa and its contiguous region with the infratemporal fossa, the prevertebral space and the skull base involved. (7) Transoral approach can be adopted forobenign tumors in the nasopharynx and pterygopalatine fossa, and low-grade malignant tumors with the pterygopalatine fossa or its contiguous region involved. (8) Nasal endoscopeapproach can be adopted for benign tumors in the nasopharynx and pterygopalatine fossa, and low-grade malignant tumors with pterygopalatine fossa or its contiguous regioninvolved.

Key words: Pterygopalatine fossa, Parapharyngeal space, Head and neck neoplasms, Surgery

中图分类号:

R739.6

廖建春, 邓斌华, 陈进璜, 胡建道, 李永德, 吕政纲, 张健, 刘环海, 纪振华, 彭浒, 刘海斌. 翼腭窝及其毗邻区域肿瘤的手术入路及临床研究[J]. 中国临床解剖学杂志, 2013, 31(6): 624-626.

LIAO Jian-Chun, DENG Bin-Hua, CHEN Jin-Huang, HU Jian-Dao, LI Yong-De, LV Zheng-Gang, ZHANG Jian, LIU Huan-Hai, JI Zhen-Hua, BANG Hu, LIU Hai-Bin-. A clinical analysis of different approach to tumors in pterygopalatine fossa and its contiguous region[J]. Chinese Journal Of Clinical Anatomy, 2013, 31(6): 624-626.

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