内镜联合等离子切除咽旁间隙肿物疗效分析

Endoscopic-Assisted Plasma Resection for Parapharyngeal and Skull Base Tumors: An Efficacy Analysis

摘要:

目的? 探讨内镜联合等离子切除咽旁间隙肿物的可行性、安全性及疗效，并总结个体化手术入路的选择策略。方法?回顾性分析2021年3月-2025年2月广西壮族自治区人民医院耳鼻咽喉头颈科收治的26例采用内镜联合等离子切除的咽旁间隙肿物患者的临床资料。其中经颈入路组（15例）和经口入路组（11例），分析26例患者的手术时间、术中出血量、术后住院时间、并发症及随访结果。结果?26例患者均顺利完成手术，全组肿瘤最大径为（50.8±14.2）mm，其中肿瘤接近颅底者9例（34.6%）。平均手术时间（295.1±123.8）min，平均术中出血量（218.5±112.7）ml，平均术后住院时间（8.3±2.8）d。术后发生声嘶1例(经颈组)，肿瘤残留1例（经口组），无术后大出血、颅内感染、死亡等严重并发症。术后病理示良性23例（88.5%），恶性3例（11.5%）。随访期内所有患者存活，未见肿瘤复发。结论?内镜联合等离子为咽旁间隙肿物切除提供了微创、精准的手术平台。经颈与经口两种入路各有优势，根据肿瘤大小、位置及其与颅底、颈内动脉的关系进行个体化选择，可在确保安全的前提下实现肿瘤完整切除。

Abstract:

Abstract Objective To evaluate the feasibility, safety, and efficacy of endoscopic-assisted plasma resection for parapharyngeal Space tumors, and to propose an individualized strategy for selecting surgical approaches. Methods A retrospective analysis was performed on 26 patients with parapharyngeal Space tumors who underwent endoscopic-assisted plasma resection at the Department of Otorhinolaryngology – Head and Neck Surgery, the People's Hospital of Guangxi Zhuang Autonomous Region from March 2021 to February 2025. The patients were divided into a transcervical approach group (n=15) and a transoral approach group (n=11). Operative time, intraoperative blood loss, postoperative hospital stay, complications, and follow-up outcomes were analyzed. Results All 26 patients underwent successful surgery. The mean maximum tumor diameter was (50.8±14.2) mm, and 9 cases (34.6%) were located close to the skull base. The mean operative time was (295.1±123.8) minutes, the mean intraoperative blood loss was (218.5±112.7) mL, and the mean postoperative hospital stay was (8.3±2.8) days. Postoperative hoarseness occurred in one patient (transcervical group), and tumor residue in one patient (transoral group). No severe complications such as massive hemorrhage, intracranial infection, or death were observed. Postoperative pathology revealed benign tumors in 23 cases (88.5%) and malignant tumors in 3 cases (11.5%). During the follow-up period, all patients survived without tumor recurrence. Conclusion Endoscopic-assisted plasma resection offers a minimally invasive and precise platform for the removal of parapharyngeal Space tumors. Both the transcervical and transoral approaches have distinct advantages. Individualized selection based on tumor size, location, and the relationship with the skull base and internal carotid artery can achieve complete tumor resection while ensuring safety.