内镜辅助下经口径路咽旁间隙的解剖

曾镇罡; 肖水芳; 贾俊晓; 王成元; 陈剑

doi:10.16098/j.issn.0529-1356.2020.05.015

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解剖学报 ›› 2020, Vol. 51 ›› Issue (5) : 726-731. DOI: 10.16098/j.issn.0529-1356.2020.05.015

解剖学与耳鼻喉科学

内镜辅助下经口径路咽旁间隙的解剖

曾镇罡¹ 肖水芳^1*贾俊晓¹王成元²陈剑²

作者信息 +

Parapharyngeal space anatomy via endoscopy-assisted transoral approach#br#

ZENG Zhen-gang¹XIAO Shui-fang^1* JIA Jun-xiao¹ WANG Cheng-yuan² CHEN Jian²

Author information +

文章历史 +

摘要

目的探讨内镜辅助下经口径路咽旁间隙的解剖结构，了解该径路重要的解剖标志及颈内动脉、颈内静脉及后组颅神经等解剖结构的毗邻关系，为内镜辅助下经口径路切除咽旁间隙肿瘤提供解剖学依据。方法在内镜辅助下对新鲜尸头标本5例(共10侧)行经口径路咽旁间隙解剖。结果茎突前间隙以咽上缩肌及翼内肌作为解剖标志，茎突咽肌、茎突舌肌是茎突前间隙的后界也是进入茎突后间隙的标志，重要的血管及后组颅神经（舌咽神经、迷走神经、副神经、舌下神经）位于茎突后间隙。以茎突尖端为标志测量距舌咽神经、舌下神经及迷走神经的水平距离分别为（3.05±0.08）mm（2.94～3.14 mm）、(2.94±0.04）mm（2.44～2.56 mm）、（1.50±0.03）mm（1.46～1.56 mm）；以茎突咽肌为标志进行测量，距舌下神经及迷走神经的水平距离分别为;（3.00±0.03）mm（2.96～3.04 mm）、（5.99±0.03）mm（5.94～6.04 mm），而舌咽神经基本紧贴该肌内侧面。副神经的走行距离茎突及茎突咽肌较远，经口手术径路几乎不会碰到。结论内镜辅助下经口径路可较好的暴露咽旁间隙结构，咽上缩肌、翼内肌、茎突咽肌、茎突舌肌是重要的解剖标志。

Abstract

Objective To observe the anatomical characteristics of the parapharyngeal space via endoscopy-assisted transoral approach.

Methods The dissection was performed on 5 fresh cadaver heads(10 sides),and the structure of the lateral pharyngeal space was observed via endoscopy-assisted transoral approach. Results The superior constrictor muscle and the musculus medial pterygoid were the landmarks of the prestyloid space．Otherwise the critical marks which divided the parapharyngeal space into 2 parts were stylopharyngeus and styloglossus muscles．The internal carotid artery, the internal jugular vein and the posterior cranial nerves were laterally to the superior constrictor muscle，and meanwhile posterior to the stylopharyngeus and styloglossus muscles．The horizontal distances from the styloid process tip to the glossopharyngeal nerve, hypoglossal nerve and vagus nerve were measured as follows, respectively（3.05±0.08）mm（2.94-3.14 mm）,（2.94±0.04）mm（2.44-2.56 mm）,（1.50±0.03）mm（1.46-1.56 mm）; with the pharyngeal muscle of styloid process as the standard the result showed that the glossopharyngeal nerve was close to the inner side of the muscle and the horizontal distance of hypoglossal nerve and vagus nerve were respectively（3.00±0.03）mm（2.96-3.04 mm）and（5.99±0.03）mm（5.94-6.04 mm）. During the anatomy, the accessry nerve was far away from styloid process and styloid process pharyngeal muscle, which could hardly be touched and measured during the operation. Conclusion The parapharyngeal space can be well exposed by endoscopicassisted transoral approach. The superior pharyngeal constrictor muscle, internal pterygoid muscle, stylopharyngeus and styloglossus muscles are essential landmarks in tumor resection of the pharyngeal space via transoral approach．

导出引用

曾镇罡肖水芳贾俊晓王成元陈剑. 内镜辅助下经口径路咽旁间隙的解剖[J]. 解剖学报. 2020, 51(5): 726-731 https://doi.org/10.16098/j.issn.0529-1356.2020.05.015

ZENG Zhen-gang XIAO Shui-fang JIA Jun-xiao WANG Cheng-yuan CHEN Jian. Parapharyngeal space anatomy via endoscopy-assisted transoral approach#br#[J]. Acta Anatomica Sinica. 2020, 51(5): 726-731 https://doi.org/10.16098/j.issn.0529-1356.2020.05.015

中图分类号： R762

参考文献

［1］ Singh M，Gupta SC，Singla A．Our experiences with parapharyngeal space tumors and systematic review of the literatu［J］. Indian J Otolaryngol Head Neck Surg，2009，61(2):112-119．
［2］ Locketz, Horowitz G, Abu-Ghanem S, et al. Histopathologic classification of parpharyngeal space tumors: a case series and review of the literature［J］. Eur Arch Otorhinolaryngol, 2016, 273(3):727-734.
［3］ Kuet ML, Kasbekar AV，Masterson L，et al. Management of tumors arising from the parapharyngeal space：a systematic review of 1293 cases reported over 25 years ［J］.Laryngoscope, 2015, 125（6）:1372-1381.
［4］ Chen H, Sun G, Tang E, et al. Surgical treatment of primary parapharyngeal space tumors: a single-institution review of 28 cases［J］. Oral Maxillofac Surg, 2019，77(7):1520.e11520.e16．
［5］ Eisele DW，Ｒichmon JD．Contemporary evaluation and management of parapharyngeal space neoplasms［J］．Laryngol Otol，2013，127(6):550-555．
［6］ Khosla S, Caton N, Zhang TT, et al. Parapharyngeal abscess secondary to lymphovenous malformation［J］．Laryngol Otol, 2019，133(3):256-259.
［7］ Aghazadeh K，Mohammadtaghi K, Rikhtegar M，et al．Surgical approaches to benign parapharyngeal space tumors-5-year experience［J］. Iran J Otorhinolaryngol，2020，32(108):43-48.
［8］ Cassoni A, Terenzi V, Della Monaca M, et al．parapharyngeal space benign tumors: our experience ［J］. J Craniomaxillofac Surg, 2014, 42 (2):101-105.
［9］ Zhang JY，Xie ZhH，Zhang H，et al．Resection of parapharyngeal neoplasms via styloid diaphragm approach［J］．Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2013,48(8):654-657. (in Chinese)
张俊毅,谢志海,章华, 等.经茎突隔膜入路切除咽旁间隙肿瘤［J］.中华耳鼻咽喉头颈外科杂志,2013,48(8):654-657.
［10］ Chen WL, Fan S, Huang ZQ, et al. Endoscopy-assisted transoral versus endoscopy-assisted transcervical minimal incision plus mandibular osteotomy approach in resection of large parapharyngeal space tumors［J］. Craniofac Surg, 2017, 28(4):976-979.
［11］ Papadogeorgakis Ｎ, Petsinis L, Goutzanis L, et al. parapharyngeal space tumors: surgical approaches in a series of 13 case［J］. Int J Oral Maxillofac Surg, 2010, 39(3):243-250.
［12］ Li PD, Chen XH, Fang JG, et al. Modified transcervical transparotid approach for high positional parapharyngeal space tumors［J］. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2013，20（7）：337-340.（in Chinese）
李平栋，陈晓红，房居高，等．改良颈-腮腺入路高位咽旁间隙肿瘤切除术探讨［J］.中国耳鼻咽喉头颈外科，2013，20（7）：337-340.
［13］ Cassoni A, Terenzi V, Della Monaca M, et al. Parapharyngeal space benign tumours: our experienc［J］. Craniomaxillofac Surg,2014, 42（2）:101-105.
［14］ Miller FR，Wanamaker JR，Lavertu P，et al．Magnetic resonance imaging and the management of parapharyngeal space tumors［J］．Head Neck，1996，18(1):67-77．
［15］ Dallan I, Seccia V, Muscatello L, et al. Transoral endoscopic anatomy of the parapharyngeal space: a step-by-step logical approach with surgical considerations ［J］. Head Neck, 2011, 33(4):557-561.
［16］ Mendelsohn AH. Transoral robotic assisted resection of the parapharyngeal space ［J］. Head Neck, 2015, 37(2): 273-280.
［17］ Chu F, De Berardinis R, Tagliabue M, et al. The role of transoral robotic surgery for parapharyngeal space: experience of a Tertiary Center ［J］. Craniofac Surg, 2020, 31(1):117-120.
［18］ Panda S, Sikka K, Thakar A, et al. Transoral robotic surgery for the parapharyngeal space: expanding the transoral corridor ［J］. J Robot Surg, 2020, 14(1):61-67.
［19］ Liu Q, Wang H, Zhao W, et al. Endoscopic transnasal transmaxillary approach to the upper parapharyngeal space and the skull base ［J］. Eur Arch Otorhinolaryngol, 2020, 277(3):801-807.
［20］ Wen F, Shen H, Gao WH, et al. Analysis and surgical treatment of 72 cases of parapharyngeal space tumors ［J］. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018,32(17): 1343-1347, 1351.（in Chinese）
文锋，沈泓，高为华，等. 72例咽旁间隙肿瘤患者的诊疗分析［J］.临床耳鼻咽喉头颈外科杂志,2018,32(17):1343-1347, 1351.
［21］ Ducic Y, Oxford L, Pontius AT. Transoral approach to the superomedial parapharyngeal space ［J］. Otolaryngol Head Neck Surg, 2006,134(3):466-470.
［22］ Gao J, Zhang BH, Zheng DSh, et al. Surgical treatment experience of different approaches in eight cases with parapharyngeal space foreign bodies ［J］. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2015,29(21):1903-1905.（in Chinese）
高静,张炳煌,郑东淑,等. 8例咽旁间隙异物不同径路手术治疗体会［J］.临床耳鼻咽喉头颈外科杂志, 2015,29(21):1903-1905.