本文關(guān)鍵詞：顱底咽旁間隙腫瘤的CT、MRI影像學(xué)特征及手術(shù)入路的選擇　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 咽旁 顱底腫瘤 電子計(jì)算機(jī)斷層掃描 磁共振成像 上頜骨外旋 下頜骨外旋 外科手術(shù)

【摘要】：目的探討顱底咽旁間隙腫瘤的CT、MRI影像學(xué)特征,為選擇不同的手術(shù)入路提供重要依據(jù)。方法回顧性分析2002年1月-2014年12月安徽醫(yī)科大學(xué)第一附屬醫(yī)院耳鼻咽喉頭頸外科經(jīng)病理明確診斷的63例顱底咽旁間隙腫瘤的臨床資料,觀察不同腫瘤的CT、MRI影像學(xué)特征(各腫瘤類型的形態(tài)、體積、性質(zhì)、有無包膜、與周圍組織的關(guān)系及有無轉(zhuǎn)移)并分析討論手術(shù)入路的選擇依據(jù)。結(jié)果本組病例中,良性腫瘤56例,惡性腫瘤7例。神經(jīng)源性腫瘤31例(49.2%),涎腺源性腫瘤為21例(33.3%)、副神經(jīng)節(jié)瘤4例包括頸動(dòng)脈體瘤3例(4.8%)和迷走體瘤1例(1.6%)、鼻咽癌顱底咽旁間隙轉(zhuǎn)移4例(6.3%)、扁桃體癌2例(3.2%)、腮腺深葉粘液表皮樣癌1例(1.6%)。本組病例中,神經(jīng)源性腫瘤與涎腺源性腫瘤均位于咽旁間隙,CT掃描多表現(xiàn)為圓形或者類圓形邊界清楚、包膜完整的腫塊,其中部分涎腺源性腫瘤表現(xiàn)為略呈分葉狀,部分腫瘤內(nèi)部可見壞死囊變區(qū)。由于二者CT表現(xiàn)無特征性,術(shù)前一般通過在CT或MRI上通過甄別腫瘤病灶與腮腺深葉的關(guān)系及頸動(dòng)脈鞘、二腹肌后腹受腫瘤推壓移位情況鑒別診斷。頸動(dòng)脈體瘤CT或MRI上表現(xiàn)為軟組織腫塊,邊界清楚,形態(tài)規(guī)則,增強(qiáng)掃描可見明顯強(qiáng)化,其特征性改變是頸內(nèi)外動(dòng)脈分離,呈高腳杯狀改變,MRI上可見瘤體內(nèi)部豐富的血管流空影,即“胡椒鹽征”。7例惡性腫瘤CT或MRI表現(xiàn)為不規(guī)則腫物低信號,部分病例合并頸部多發(fā)性腫大淋巴結(jié)影,可融合,增強(qiáng)掃描可見部分強(qiáng)化,可伴有壞死。本組63例病例均全麻下手術(shù)切除,手術(shù)入路如下:31例神經(jīng)源性腫瘤中的6例采用單純內(nèi)鏡切除;31例神經(jīng)源性腫瘤中的10例及2例頸動(dòng)脈體瘤采用頸側(cè)入路,其中6例聯(lián)合鼻內(nèi)鏡入路;1例迷走體瘤、1例頸內(nèi)動(dòng)脈體瘤、1例扁桃體癌及2例巨大涎腺源性腫瘤采用下頜骨外旋入路切除。其他下頜骨不同處理入路切除22例,方式包括下頜骨前上牽拉入路、半側(cè)下頜骨切除入路、下頜骨升支離斷再復(fù)位入路及下頜骨升支部分切除入路。上頜骨外旋入路切除6例,為神經(jīng)源性腫瘤4例及伴張口困難的鼻咽癌2例;眶顴入路切除2例,均為侵犯前中顱底的顱底咽旁間隙神經(jīng)鞘瘤。所有腫瘤均完整切除,顱底咽旁缺損修復(fù)根據(jù)缺損大小及有無骨質(zhì)破壞采用胸大肌皮瓣、舌瓣、自體帽狀筋膜瓣以及頦下瓣等修復(fù)。術(shù)后3例出現(xiàn)聲音嘶啞;3例發(fā)生Horner綜合征;2例復(fù)發(fā)鼻咽癌術(shù)后張口困難明顯改善。12例氣管切開患者的10例于術(shù)后半年內(nèi)拔除氣管套管。33例涉及上下頜骨不同入路的患者均未出現(xiàn)明顯影響進(jìn)食的咬合關(guān)系錯(cuò)亂。惡性腫瘤術(shù)后綜合治療,術(shù)后隨訪2-14年,良性腫瘤未見復(fù)發(fā),惡性腫瘤中死亡3例,為扁桃體腺樣囊腺癌1例及復(fù)發(fā)鼻咽癌2例。結(jié)論:CT、MRI影像學(xué)可提供顱底咽旁間隙腫瘤的一些影像學(xué)特征,正確認(rèn)識(shí)并利用影像學(xué)提供的這些特征如腫瘤的形態(tài)、密度、與周圍組織關(guān)系、增強(qiáng)掃描后瘤體的強(qiáng)化情況以及瘤體內(nèi)部情況等特征,對提高顱底咽旁間隙腫瘤的早期診斷和鑒別診斷具有重要意義。術(shù)前有效利用和評估這些特征有助于選擇合適的手術(shù)入路及提高手術(shù)效率和安全性,降低手術(shù)并發(fā)癥。
[Abstract]:Objective to investigate the skull base tumors in the parapharyngeal space CT, MRI imaging, for the choice of surgical approach. The method provides an important basis for the retrospective analysis of clinical data of 63 patients with skull base of Otolaryngology Head and neck surgery, January 2002 -2014 year in December in the First Affiliated Hospital of Medical University Of Anhui definite pathological diagnosis of tumors in the parapharyngeal space, observed tumor CT MRI, imaging features (the type of tumor morphology, size, nature, there is no capsule, the relationship with the surrounding tissue and metastasis) and discuss the selection basis of surgical approach. Results in this group of cases, 56 cases of benign tumor, malignant tumor in 7 cases. 31 cases of neurogenic tumor (49.2%), salivary gland tumors in 21 cases (33.3%), including 4 cases of paraganglioma of carotid body tumor in 3 cases (4.8%) and aberrant body tumor in 1 cases (1.6%) of nasopharyngeal carcinoma, skull base parapharyngeal metastasis in 4 cases (6.3%), 2 cases of tonsillar cancer (3.2%), the deep lobe of the parotid gland mucus table 1 cases of dermoid cancer (1.6%). In this group of cases, neurogenic tumors and salivary gland tumors were located in the parapharyngeal space, CT scan showed round or oval clear boundary, encapsulated mass, which showed some salivary neoplasm slightly lobulated, necrotic or cystic part of the tumor inside area. Because the two CT showed no specific features, preoperative general through CT or MRI through the relationship between the carotid sheath and screening tumor lesions and the deep lobe of the parotid gland, two pbdm by shifting the differential diagnosis of carotid body tumor. CT or MRI showed soft tissue mass with clear boundary form, rules, enhanced scan showed obvious enhancement, the characteristic changes of internal carotid and external carotid, a goblet shape change, MRI showed tumor abundant internal flow void vessels, namely "salt and pepper" sign.7 cases of malignant tumors in CT or MRI showed irregular low mass Signal fusion shadow, multiple lymph nodes were combined with the neck, enhanced visible enhancement, accompanied by necrosis. Resection of 63 cases in this group were under general anesthesia surgery, the surgical approach is as follows: 31 cases of neurogenic tumors in 6 cases were treated with endoscopic resection; 31 cases of neurogenic tumors in 10 cases and 2 cases of carotid body tumor by transcervical approach, among which 6 cases were combined with nasal endoscopic approach; 1 cases of aberrant tumor, 1 cases of carotid body tumor, 1 cases of tonsil carcinoma and 2 cases of salivary gland tumors with large mandibular swing approach for resection of mandible in the other. Physical approach resection in 22 cases, including pull into the road before the mandibular distraction, hemimandibular approach, and then reset the fragmented broken mandible ascending approach and mandibular ramus resection approach. The maxillary swing approach for resection in 6 cases, 2 cases of neurogenic tumor and 4 cases with trismus nasopharyngeal carcinoma; orbitozygomatic Approach of resection in 2 cases, both the anterior and middle skull base of skull base invasion of parapharyngeal space neoplasms. All tumors were resected completely, parapharyngeal skull base defect repair according to the defect size and no bone destruction by pectoralis major myocutaneous flap, tongue flap, flap and autologous cap submental flap repair occurred in 3 cases. Hoarseness occurred in 3 cases; Horner syndrome; trismus 2 cases of recurrent nasopharyngeal carcinoma after surgery significantly improved.12 cases of tracheotomy patients in 10 patients within six months after the removal of the tracheal tube.33 cases involving mandible in different way patients showed no obvious effects of occlusal relationship eating disorder. After the resection of malignant tumors in comprehensive treatment. Patients were followed up for 2-14 years, no recurrence of benign tumor, 3 cases died of malignant tumors, 1 cases of tonsil adenoid cystic carcinoma and recurrent nasopharyngeal carcinoma in 2 cases. Conclusion: CT can provide some images of skull base tumors in the parapharyngeal space features of MRI imaging, is To understand and learn these features provide such as tumor morphology, using image density, relationship with surrounding tissue, after enhancement tumor enhancement and tumor internal conditions and other characteristics, it has important significance to improve the early diagnosis and differential diagnosis of basicranial parapharyngeal tumor. Preoperative evaluation and effective use of these features help to choose the appropriate surgical approach and improve the operation efficiency and safety, reduce the complications.

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R739.6

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 熊新高,楊成章,汪廣平,劉邦華;咽旁間隙腫瘤48例報(bào)告[J];臨床耳鼻咽喉科雜志;2000年02期

2 鐘國輝,陳文寬,伍國號;咽旁間隙腫瘤40例分析[J];九江醫(yī)學(xué);2000年03期

3 夏長金 ,胡萬寧;咽旁間隙腫瘤67例診治分析[J];中國煤炭工業(yè)醫(yī)學(xué)雜志;2001年12期

4 葛俊恒 ,胡俊蘭 ,趙瑞利;咽旁間隙腫瘤45例療效分析[J];中國綜合臨床;2002年08期

5 趙玉林,婁衛(wèi)華,呂明栓,董明敏;咽旁間隙腫瘤24例診治體會(huì)[J];鄭州大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2003年05期

6 傅明,管志偉,鐘潤蘭,黃鶴年;咽旁間隙腫瘤臨床分析[J];中國基層醫(yī)藥;2004年08期

7 王薇;;咽旁間隙腫瘤的診斷和治療[J];中國眼耳鼻喉科雜志;2005年03期

8 劉亭彥;吳正虎;彭華光;;原發(fā)性咽旁間隙腫瘤的診斷及治療[J];中國耳鼻咽喉頭頸外科;2006年10期

9 梁建民;劉暉;王建剛;;咽旁間隙腫瘤132例臨床分析[J];現(xiàn)代腫瘤醫(yī)學(xué);2006年12期

10 宋衛(wèi)琪;;咽旁間隙腫瘤的手術(shù)治療[J];臨床和實(shí)驗(yàn)醫(yī)學(xué)雜志;2007年03期

相關(guān)會(huì)議論文 前10條

1 鄧毅;吳元慶;陳榮榮;初亭;;咽旁間隙巨大腫瘤的切除[A];中華醫(yī)學(xué)會(huì)第十次全國耳鼻咽喉-頭頸外科學(xué)術(shù)會(huì)議論文匯編（下）[C];2007年

2 沈曉輝;高下;錢曉云;俞晨杰;蔣媛;;頸側(cè)入路切除咽旁間隙腫瘤[A];中華醫(yī)學(xué)會(huì)第十次全國耳鼻咽喉-頭頸外科學(xué)術(shù)會(huì)議論文匯編（下）[C];2007年

3 廖楚航;陳剛;劉曙光;王大章;李揚(yáng);鄭光勇;;咽旁間隙腫瘤的臨床特點(diǎn)及診斷與治療[A];第一屆全國口腔頜面部腫瘤學(xué)術(shù)會(huì)議論文匯編[C];2001年

4 劉亭彥;吳正虎;周雪華;蔣建華;丁吉女;;原發(fā)性咽旁間隙腫瘤[A];2005年浙江省耳鼻咽喉科學(xué)術(shù)會(huì)議論文匯編[C];2005年

5 徐婭蘋;;巨大咽旁間隙惡性腫瘤診治經(jīng)驗(yàn)[A];2005年浙江省耳鼻咽喉科學(xué)術(shù)會(huì)議論文匯編[C];2005年

6 宋濟(jì)昌;;咽旁間隙腫瘤[A];中華醫(yī)學(xué)會(huì)第十三屆全國放射學(xué)大會(huì)論文匯編（上冊）[C];2006年

7 何三綱;李祖兵;趙吉宏;張文峰;劉冰;東耀峻;趙怡芳;;旋轉(zhuǎn)法摘除原發(fā)于咽旁間隙的良性腫瘤[A];第五次全國口腔頜面—頭頸腫瘤學(xué)術(shù)研討會(huì)論文匯編[C];2006年

8 趙銘;劉善廷;齊金星;;咽旁間隙腫瘤的診斷及手術(shù)入路[A];第四屆中國腫瘤學(xué)術(shù)大會(huì)暨第五屆海峽兩岸腫瘤學(xué)術(shù)會(huì)議論文集[C];2006年

9 徐雷鳴;;咽旁間隙腫瘤：四組解剖結(jié)構(gòu)移位征及其意義[A];2007年浙江省放射學(xué)學(xué)術(shù)年會(huì)論文匯編[C];2007年

10 鄧毅;吳元慶;陳榮榮;初亭;;巨大咽旁間隙腫瘤的手術(shù)入路選擇[A];中華醫(yī)學(xué)會(huì)第十次全國耳鼻咽喉-頭頸外科學(xué)術(shù)會(huì)議論文匯編（下）[C];2007年

相關(guān)重要報(bào)紙文章 前3條

1 中國醫(yī)學(xué)科學(xué)院腫瘤醫(yī)院教授 屠規(guī)益;咽旁間隙腫瘤宜從頸側(cè)入路[N];健康報(bào);2009年

2 廣東佛山第一人民醫(yī)院 段園暉;多科聯(lián)手挖出巨瘤[N];健康報(bào);2009年

3 劉東朱　廣平記者　蔣寒;切除高難度咽旁間隙神經(jīng)鞘膜瘤[N];科技日報(bào);2006年

相關(guān)博士學(xué)位論文 前2條

1 劉邦華;咽旁間隙腫瘤的診斷和治療[D];華中科技大學(xué);2006年

2 王曉彬;經(jīng)口內(nèi)鏡輔助咽旁間隙臨床應(yīng)用解剖及咽旁間隙腫瘤內(nèi)鏡輔助經(jīng)口內(nèi)入路切除術(shù)的臨床研究[D];山東大學(xué);2014年

相關(guān)碩士學(xué)位論文 前5條

1 付強(qiáng);原發(fā)性咽旁間隙腫瘤80例的診斷與治療分析[D];山東大學(xué);2016年

2 阮洋;44例咽旁間隙腫瘤的臨床分析[D];吉林大學(xué);2008年

3 李兆生;咽旁間隙的相關(guān)側(cè)顱底應(yīng)用解剖研究[D];福建醫(yī)科大學(xué);2007年

4 羅興谷;內(nèi)鏡輔助口內(nèi)入路咽旁間隙腫瘤摘除臨床應(yīng)用研究[D];廣州醫(yī)科大學(xué);2014年

5 潘代;鼻咽癌侵犯咽旁間隙的超聲表現(xiàn)及其臨床價(jià)值[D];廣西醫(yī)科大學(xué);2013年

，

本文編號：1440399