翼腭窝及其毗邻区域肿瘤的手术入路及临床研究

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。

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

Objective　To analyze the best approach for treatment of tumors in the pterygopalatine fossa and its contiguous region.　Methods　The data of 108 cases oftumors 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.