咽旁间隙肿瘤的临床分析及手术方式探讨

doi:10.12439/kqhm.1005-4979.2025.06.001

《口腔颌面外科杂志》 ›› 2025, Vol. 35 ›› Issue (6): 423-429. doi: 10.12439/kqhm.1005-4979.2025.06.001

• 专家论坛 • 下一篇

咽旁间隙肿瘤的临床分析及手术方式探讨

李子慧(), 李馥焰, 孙国文()

南京大学医学院附属口腔医院，南京市口腔医院口腔颌面外科，南京 210008

收稿日期:2025-05-20 接受日期:2025-07-07 出版日期:2025-12-28 上线日期:2025-12-25
通讯作者: 孙国文，副教授. E-mail: guowensun@nju.edu.cn

作者简介:

李子慧，博士研究生. E-mail: zihui.lee@foxmail.com

专家简介　孙国文，南京市口腔医院，南京大学医学院附属口腔医院口腔颌面外科（国家临床重点专科）一病区主任，主任医师，硕士生导师。现任中华口腔医学会牙与牙槽外科专业委员会常务委员、中华口腔医学会头颈肿瘤外科专业委员会委员、中华口腔医学会口腔颌面外科专业委员会委员、中国医师协会显微外科分会委员、中国整形美容协会精准与数字医学分会颅颌面整复专业委员会常务委员、江苏省口腔医学会牙及牙槽外科专业委员会主任委员、江苏省整形美容协会颌面整形分会候任主任委员、江苏省抗癌协会头颈肿瘤专业委员会副主任委员、江苏省医学会显微外科分会副主任委员、江苏省康复医学会修复重建专业委员会常务委员、江苏省医学会肿瘤分会黑色素瘤学组委员等。入选为江苏省“333高层次人才培养工程”培养对象，并获封江苏省第一批“卫生拔尖人才”、南京地区“十佳医生”等多项荣誉称号。曾获江苏省科技进步奖二等奖2项，江苏省医学新技术引进一等奖4项，江苏省医学新技术引进二等奖1项。累计发表学术论文140余篇，其中SCI收录论文40余篇，以第一作者或通信作者发表SCI收录论文30余篇。

基金资助:
南京市卫生科技发展专项基金项目(YKK22183)

Clinical analysis and surgical approaches for parapharyngeal space tumors

LI Zihui(), LI Fuyan, SUN Guowen()

Department of Oral and Maxillofacial Surgery, Nanjing Stomatology Hospital, Medical School of Nanjing University, Nanjing 210008, China

Received:2025-05-20 Accepted:2025-07-07 Published:2025-12-28 Online:2025-12-25

摘要/Abstract

摘要：

咽旁间隙（parapharyngeal space，PPS）是头颈部深在解剖间隙，内含颈内动脉、脑神经等重要结构，该位置的原发肿瘤临床上较为罕见。手术切除是治疗该区域肿瘤的首选方法，而选择恰当的手术入路是确保肿瘤安全切除、减少术后并发症的关键。本文结合近年文献与笔者团队临床实践经验，基于PPS三维分区，系统梳理与评述其主要手术入路，以期为临床术式的选择提供参考。

关键词: 口腔肿瘤, 咽旁间隙肿瘤, 手术入路

Abstract:

Parapharyngeal space (PPS) is a deep anatomical compartment in the head and neck region, containing critical structures such as the internal carotid artery and cranial nerves. Primary tumors in this area are relatively rare. Surgical resection remains the primary treatment for tumors in this region, and selecting an appropriate surgical approach is crucial for ensuring safe tumor removal and minimizing postoperative complications. Based on recent literatures and the clinical experiences of our team, this article systematically reviews and discusses the main surgical approaches based on the three-dimensional compartmentalization of the PPS, aiming to provide a reference for selecting appropriate clinical surgical strategies.

Key words: mouth neoplasms, parapharyngeal space tumors, surgical approach

中图分类号:

R782
R739.8

李子慧, 李馥焰, 孙国文. 咽旁间隙肿瘤的临床分析及手术方式探讨[J]. 《口腔颌面外科杂志》, 2025, 35(6): 423-429.

LI Zihui, LI Fuyan, SUN Guowen. Clinical analysis and surgical approaches for parapharyngeal space tumors[J]. 《Journal of Oral and Maxillofacial Surgery》, 2025, 35(6): 423-429.

https://journal06.magtech.org.cn/Jweb_joms/CN/Y2025/V35/I6/423

图/表 7

图1 PPS的分区 A. PPS轴位分区：茎突及其附着肌肉、韧带、筋膜组成的隔膜将PPS分为茎突前、后2个间隙，红色虚线示茎突及其附着肌群；B. PPS冠状位分区：a线连接两侧翼外肌下缘，b线连接两侧下颌角的下缘，c线位于舌骨平面。依据上述连线将PPS分为上腔室、中腔室和下腔室。

Figure 1 Compartmentalization of the PPS

表1 PPS冠状位分区及标志

Table 1 Coronal compartmentalization and anatomical landmarks of the PPS

冠状分区	影像学分界标志
上腔室	颅底至两侧翼外肌下缘的连线之间
中腔室	两侧翼外肌下缘的连线至两侧下颌角的连线之间
下腔室	两侧下颌角的连线与舌骨平面之间

表2 PPS肿瘤的主要手术入路及适应证

Table 2 Main surgical approaches and their indications for PPS tumors

手术入路	适应证
经颈入路	PPS下腔室良性或恶性肿瘤、茎突前间隙良性肿瘤
经腮腺或经腮-颈入路	PPS中腔室的较大肿瘤、茎突前间隙良性肿瘤、腮腺深叶肿瘤
经颞下窝入路	PPS上腔室肿瘤，累及颅底或颈静脉孔的肿瘤，延伸至颞下窝，或明显延伸至颅内的肿瘤
经下颌骨入路	恶性肿瘤、多灶性复发的良性肿瘤、直径较大的肿瘤，部分PPS上腔室肿瘤，累及颈内动脉和邻近颅底的肿瘤
经口入路	茎突前间隙较小、血供较少、包膜完整的良性肿瘤

图2 经腮-颈入路摘除右侧PPS中间腔室巨大腮腺混合瘤 A.术前轴位CT平扫示右侧茎突前间隙类圆形占位，边界清晰，红色箭头指示肿瘤；B.冠状位CT图像示肿瘤主体位于PPS中间腔室，红色箭头指示肿瘤；C.手术入路选择经腮-颈入路；D.术中精细分离并保护面神经，完整显露肿瘤（白色箭头）；E.完整摘除腮腺混合瘤，最大直径约为8.5 cm。

Figure 2 Transparotid-cervical approach for resection of a giant pleomorphic adenoma in the middle compartment of the right PPS

图3 经下颌骨入路的多种劈开形式从左到右依次为：①髁突颈部劈开入路；②下颌角劈开入路；③下颌颏孔前劈开入路；④下颌正中或旁正中劈开入路。

Figure 3 Various osteotomy types of the transmandibular approach

图4 手术导航下经下颌正中劈开联合颈部入路摘除左侧PPS中上腔室神经鞘瘤 A.术前轴位MRI：左侧茎突后间隙类圆形肿块（红色箭头所指）；B.矢状位MRI：肿瘤主体占据PPS中上腔室，向颅底颈静脉孔延伸，红色箭头示肿块；C.下颌骨中线劈开联合颈部弧形切口设计；D.术中牵拉保护舌神经（白色箭头所指），导航探针实时定位肿瘤；E.术中手术导航技术，三维实时探测肿瘤界限，识别肿瘤与颅底位置关系及颅底关键组织；F.完整摘除神经鞘瘤，最大直径约为3.5 cm。

Figure 4 Resection of a schwannoma in the middle and upper compartments of the left PPS via midline osteotomy of the mandibular body and a cervical approach under intraoperative navigation

图5 经口入路摘除右侧PPS巨大混合瘤 A.术前冠状位CT示右侧PPS类圆形低密度肿块（红色箭头所指）；B.经口入路，术中充分暴露肿瘤；C.完整摘除右侧PPS混合瘤，肿物包膜完整，最大直径约为5 cm。

Figure 5 Transoral resection of a giant pleomorphic adenoma in the right PPS

参考文献 45

[1]	Bowen A. Parapharyngeal space[M]. Boca Raton: CRC Press eBooks, 2022: 306-308.
[2]	陈昊亮, 孙国文, 唐恩溢, 等. 23例原发性PPS肿瘤的临床分析及手术方式探讨[J]. 中华口腔医学杂志, 2019, 54(2): 107-111.
[3]	Rigsby RK, Bhatt AA. Primary pathology of the parapharyngeal space[J]. Clin Neuroradiol, 2023, 33(4): 897-906. doi: 10.1007/s00062-023-01316-9
[4]	Rai P, Bhattacharya K, Rastogi S, et al. Beyond the throat: Imaging of parapharyngeal space lesions[J]. Clin Radiol, 2024, 79(12): 912-920. doi: 10.1016/j.crad.2024.08.030 URL
[5]	凌志明, 曾泉. PPS肿瘤不同手术入路选择策略及疗效分析[J]. 中国耳鼻咽喉头颈外科, 2023, 30(9): 545-550.
[6]	Koenig LJ, Tamimi D, Perschbacher SE, eds. Parapharyngeal space[M]// Diagnostic imaging: Oral and maxillofacial. 2nd ed. Amsterdam: Elsevier, 2017: 168-171.
[7]	高前进, 焦坤鹏, 赵平小, 等. PPS恶性肿瘤并颈淋巴结转移1例[J]. 现代医药卫生, 2024, 40(13): 2338-2340.
[8]	López F, Suárez C, Vander Poorten V, et al. Contemporary management of primary parapharyngeal space tumors[J]. Head Neck, 2019, 41(2): 522-535. doi: 10.1002/hed.v41.2 URL
[9]	Hermans R. Parapharyngeal space neoplasms[M]// Head and neck cancer imaging. Cham: Springer International Publishing, 2020: 237-252.
[10]	Shanmugam S, Susikar S, Vijayalakshmi G. Parapharyngeal space tumors-what lies in this hidden space[J]. Indian J Otolaryngol Head Neck Surg, 2023, 75(4): 3847-3849. doi: 10.1007/s12070-023-03551-5
[11]	Bulut OC, Giger R, Alwagdani A, et al. Primary neoplasms of the parapharyngeal space: Diagnostic and therapeutic pearls and pitfalls[J]. Eur Arch Otorhinolaryngol, 2021, 278(12): 4933-4941. doi: 10.1007/s00405-021-06718-4 pmid: 33740083
[12]	余燕丽, 陈旭东, 王玥, 等. PPS肿瘤25例临床分析[J]. 现代实用医学, 2024, 36(9): 1172-1174.
[13]	Aslan M, Ozer Ozturk E, Dogukan FM. A rare cause of dysphagia: Giant lipoma in parapharyngeal space[J]. J Craniofacial Surg, 2020, 31(7): e667-e668. doi: 10.1097/SCS.0000000000006503 URL
[14]	Strohl MP, El-Sayed IH. Contemporary management of parapharyngeal tumors[J]. Curr Oncol Rep, 2019, 21(11): 103. doi: 10.1007/s11912-019-0853-8 pmid: 31728649
[15]	Faisal M, Seemann R, Fischer G, et al. Neurological complications in benign parapharyngeal space tumors- systematic review and meta-analysis[J]. Int Arch Otorhinolaryngol, 2023, 27(1): e158-e165. doi: 10.1055/s-0042-1744164 URL
[16]	Komune N, Matsuo S, Nakagawa T. The fascial layers attached to the skull base: A cadaveric study[J]. World Neurosurg, 2019, 126: e500-e509. doi: 10.1016/j.wneu.2019.02.078
[17]	石小玲, 陶磊. PPS肿瘤手术入路的研究进展[J]. 中国眼耳鼻喉科杂志, 2016, 16(2): 135-137, 140.
[18]	侯佳欣, 王玲, 曾泉, 等. 咽旁间隙肿瘤影像学与治疗方式选择[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(10): 937-941.
[19]	Shahinian H, Dornier C, Fisch U. Parapharyngeal space tumors: The infratemporal Fossa approach[J]. Skull Base Surg, 1995, 5(2): 73-81. pmid: 17171180
[20]	Kanzaki S, Nameki H. Standardised method of selecting surgical approaches to benign parapharyngeal space tumours, based on pre-operative images[J]. J Laryngol Otol, 2008, 122(6): 628-634. pmid: 17655777
[21]	Prasad SC, Piccirillo E, Chovanec M, et al. Lateral skull base approaches in the management of benign parapharyngeal space tumors[J]. Auris Nasus Larynx, 2015, 42(3): 189-198. doi: 10.1016/j.anl.2014.09.002 pmid: 25270862
[22]	Joshi P, Joshi KD, Nair S, et al. Surgical management of parapharyngeal tumors: Our experience[J]. South Asian J Cancer, 2021, 10(3): 167-171. doi: 10.1055/s-0041-1731580 pmid: 34938679
[23]	Shin BJ, Lee DH, Lee JK, et al. Surgical treatment of parapharyngeal space salivary gland tumor[J]. J Craniofac Surg, 2022, 33(7): e676-e679. doi: 10.1097/SCS.0000000000008565 URL
[24]	赵建东, 文艺, 纵亮, 等. 原发性咽旁间隙肿瘤治疗的回顾性分析[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(8): 743-747.
[25]	Matsuki T, Okamoto I, Tada Y, et al. Resection of parapharyngeal space tumors located in the prestyloid compartment: Efficacy of the cervical approach[J]. Ann Surg Oncol, 2021, 28(6): 3066-3072. doi: 10.1245/s10434-020-09268-x pmid: 33141372
[26]	Marzouki H, Nujoom M, Fagih SN, et al. Surgical parapharyngeal space tumor analysis with case series study[J]. Comput Intell Neurosci, 2022, 2022: 7083240.
[27]	Osborne RF. Transoral parotidectomy[J]. Oral Maxillofac Surg Clin N Am, 2021, 33(2): 169-175. doi: 10.1016/j.coms.2020.12.002 URL
[28]	张大明, 陈伟良, 林钊宇, 等. 下颌下入路联合下颌支冠状劈开切除咽旁肿瘤的探讨[J]. 中国口腔颌面外科杂志, 2014, 12(3): 243-246.
[29]	Smith GI, Brennan PA, Webb AA, et al. Vertical ramus osteotomy combined with a parasymphyseal mandibulotomy for improved access to the parapharyngeal space[J]. Head Neck, 2003, 25(12): 1000-1003. doi: 10.1002/hed.v25:12 URL
[30]	Teng MS, Genden EM, Buchbinder D, et al. Subcutaneous mandibulotomy: A new surgical access for large tumors of the parapharyngeal space[J]. Laryngoscope, 2003, 113(11): 1893-1897. pmid: 14603042
[31]	Lao WP, Han PS, Lee NH, et al. Transoral excision of parapharyngeal tumors[J]. Ear Nose Throat J, 2021, 100(10): NP454-NP458. doi: 10.1177/0145561320923171 URL
[32]	Ducic Y, Oxford L, Pontius AT. Transoral approach to the superomedial parapharyngeal space[J]. Otolaryngol Head Neck Surg, 2006, 134(3): 466-470. doi: 10.1016/j.otohns.2005.10.003 pmid: 16500446
[33]	Yavuz H, Vural O. Transoral approach to the giant deep lobe parotid gland pleomorphic adenoma[J]. J Craniofac Surg, 2021, 32(5): e491-e493. doi: 10.1097/SCS.0000000000007449 pmid: 33464770
[34]	Floros P, Sorrentino M, Magnuson JS. Transoral robotic parapharyngeal approach to the submandibular space[J]. Head Neck, 2020, 42(12): 3776-3778. doi: 10.1002/hed.v42.12 URL
[35]	Salzano G, Togo G, Maglitto F, et al. Transoral robotic surgery: 14 cases of pleomorphic adenoma of the parapharyngeal space[J]. J Craniofacial Surg, 2022, 33(5): 1587-1590. doi: 10.1097/SCS.0000000000008477 URL
[36]	Larson AR, Ryan WR. Transoral excision of parapharyngeal space tumors[J]. Otolaryngol Clin North Am, 2021, 54(3): 531-541. doi: 10.1016/j.otc.2021.03.001 URL
[37]	Miller JE, Sajed DP, Mendelsohn AH. Transoral robotic surgery for a parapharyngeal space tumor[J]. JAMA Otolaryngol Head Neck Surg, 2023, 149(7): 645-646. doi: 10.1001/jamaoto.2023.0904 URL
[38]	Zhang DK, Yan HL, Chen HH, et al. A comparative study of transcervical, endoscope-assisted transcervical, and endoscope-assisted transoral resection of retrostyloid space schwannomas[J]. Head Neck, 2024, 46(9): 2107-2115. doi: 10.1002/hed.v46.9 URL
[39]	Smith JD, Chinn SB, Sridharan S, et al. Endoscope-assisted transcervical resection of parapharyngeal space tumors[J]. Otolaryngol Head Neck Surg, 2025, 172(1): 162-166. doi: 10.1002/ohn.v172.1 URL
[40]	Guo DN, Sun CL, Yin X, et al. A retrospective analysis on the effects and complications of endoscope-assisted transoral approach and lateral cervical approach in the resection of parapharyngeal space tumors[J]. Comput Intell Neurosci, 2022, 2022: 7536330.
[41]	O’Malley BW Jr, Quon H, Leonhardt FD, et al. Transoral robotic surgery for parapharyngeal space tumors[J]. ORL J Otorhinolaryngol Relat Spec, 2010, 72(6): 332-336. doi: 10.1159/000320596 URL
[42]	Dabas SK, Menon NN, Ranjan R, et al. Transoral robotic surgery for a rare case of venolymphatic malformation in parapharyngeal space[J]. Indian J Otolaryngol Head Neck Surg, 2024, 76(2): 2035-2041. doi: 10.1007/s12070-023-04390-0
[43]	Sharma V, Panda NK, Bakshi J, et al. Transoral robotic approach to parapharyngeal space tumors: Changes in paradigm of surgery[J]. Indian J Otolaryngol Head Neck Surg, 2024, 76(5): 4974-4978. doi: 10.1007/s12070-024-04853-y
[44]	孟令照, 杨帆, 饶远生, 等. 经口机器人手术切除PPS肿瘤的临床应用及远期疗效分析[J]. 实用临床医药杂志, 2025, 29(7): 38-42.
[45]	Tang R, Mao S, Liu SX, et al. Types of endoscopic surgical approaches for benign parapharyngeal space tumors[J]. Oral Oncol, 2022, 130: 105875.

选择文件类型/文献管理软件名称

选择包含的内容

咽旁间隙肿瘤的临床分析及手术方式探讨

Clinical analysis and surgical approaches for parapharyngeal space tumors

RichHTML

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

图/表 7

参考文献 45

相关文章 8

编辑推荐

Metrics

本文评价

[1]	张鑫, 邸瑞玲, 李璁, 王宁, 李向春, 路彤彤. 潜突型舌下腺囊肿术后复发1例及文献回顾[J]. 《口腔颌面外科杂志》, 2024, 34(5): 408-412.
[2]	程维, 肖祎婷, 李雅冬. 腮腺前缘咬肌入路与穿腮腺入路手术治疗髁突骨折患者术后并发症的对比[J]. 《口腔颌面外科杂志》, 2024, 34(2): 122-128.
[3]	单宇博, 庞湃, 杨鸣良, 孙长伏. 数字化导航辅助下切除翼腭窝神经鞘瘤1例病例报道[J]. 《口腔颌面外科杂志》, 2020, 30(5): 337-339.
[4]	冯大军，蒋勇，孙云峰. 改良下唇切口进路切除口腔恶性肿瘤[J]. 《口腔颌面外科杂志》, 2018, 28(4): 215-218.
[5]	孔月虹, 涂文勇, 程昌明,丁继平, 徐璇丽. 放疗早期对口腔颌面部肿瘤患者免疫功能影响的临床研究[J]. 《口腔颌面外科杂志》, 2016, 26(2): 110-114.
[6]	刘丰1，俞志维2，刘胜文2，朱云2，杨雯君2. 咽旁间隙肿瘤手术入路10例分析[J]. 《口腔颌面外科杂志》, 2015, 25(3): 216-.
[7]	李博1,2，李黎3，黄一冰1，郭黛墨1，潘唯一1，段泽西1，邹晓莉3，朱彩蓉3，谢蟪旭1,2. 口腔肿瘤患者心理压力与体内相关因素变化的初探[J]. 《口腔颌面外科杂志》, 2013, 23(5): 369-373.
[8]	袁灏，史俊，唐友盛，徐兵，沈国芳. 耳周切口治疗髁突颈部骨折[J]. 《口腔颌面外科杂志》, 2012, 22(1): 33-36.

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

咽旁间隙肿瘤的临床分析及手术方式探讨

Clinical analysis and surgical approaches for parapharyngeal space tumors

RichHTML

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

图/表 7

参考文献 45

相关文章 8

编辑推荐

Metrics

本文评价