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·头颈疾病·

原发性咽周围间隙神经鞘膜瘤的诊断与治疗

作者:张学辉 肖 平 刘华盛 张沈华

所属单位:广东省第二人民医院耳鼻咽喉头颈外科 (广东 广州 510317)

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摘要

目的 探讨原发性咽周围间隙神经鞘膜瘤的诊断与治疗及其疗效。方法 总结7例咽周围间隙神经鞘膜瘤的临床资 料。分析临床体征和手术方法,采用颈侧径路5例、颈颌径路2例。结果 咽旁隙肿瘤5例、咽后隙肿瘤2例,与影像 学诊断相符。病理学结果为神经鞘膜瘤,均为良性。无术后大出血或呼吸困难病例,无术后感染或咽瘘病例,全组 病例Ⅰ期愈合。经随访1年至3年,无复发病例。结论 原发性咽周围间隙神经鞘膜瘤临床罕见,影像学检查是定位定 性诊断的基础,颈侧切开或颈颌径路是唯一有效治疗方法。

Objective To investigate the diagnosis, therapy and treatment effect of primary gap pharyngeal space around nerve sheath tumors. Methods 7 cases of clinical data of nerve sheath tumors around pharyngeal were studied. Clinical signs and surgical methods were analyzed, with lateral neck pathway in five cases, cervical jaw pathways in two cases. Results Gap parapharyngeal tumor in five cases, retropharyngeal tumors in two cases, were consistent with the imaging diagnosis. Pathology results for nerve sheath tumors, were benign ,with.no cases of postoperative bleeding or dyspnea, no postoperative infection or pharyngeal fistula patients,while , all patients were Ⅰ Healing. After follow-up of 1 year to 3 years, there was no recurrence. Conclusions Primary pharyngeal space around nerve Sheath tumors are rare, with clinical imaging diagnosis positioning the foundation base,.and the throat or neck incision jaw pathway is the only effective treatment.

【关键词】咽周围间隙;神经鞘膜瘤;磁共振成像;诊断/治疗

【中图分类号】R322.4+2

【文献标识码】A

【DOI】10.3969/j.issn.1009-3257.2015.05.002

前言

原发于咽周围间隙(peripharyngeal space) 的肿瘤临床少见,而原发于此区域的神经鞘膜瘤 (neurolemmoma)临床更为罕见。该区域位置深在隐 匿,解剖结构复杂,使其发生于此的肿瘤定性困难, 易发生错诊或误诊。熟悉该区域应用解剖,应用影像 学资料初步明确诊断,了解肿瘤与毗邻组织的关系, 是外科治疗成功的必需条件。本文报道7例原发于咽 周围间隙的神经鞘膜瘤病例,进行临床特征和手术径 路分析,旨在提高耳鼻咽喉头颈外科医师对原发于此 区域肿瘤的诊断与治疗水平。