鼻咽部血管纤维瘤的血管内介入诊疗  

Angiography and preoperative embolization of nasopharyngeal agiofibromas

作　　者：戚跃勇[1] 邹利光[1] 王文献[1] 孙清荣[1] 梁开运[1] 杨桦[1] 

机构地区：[1]第三军医大学附属新桥医院放射科,重庆400037

出　　处：《中国耳鼻咽喉颅底外科杂志》2005年第2期102-105,共4页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的探讨鼻咽部血管纤维瘤的血管造影诊断和术前栓塞治疗价值。方法回顾性分析16例鼻咽部血管纤维瘤(栓塞组)的选择性动脉造影与双重栓塞的治疗资料,并选择11例未行术前栓塞的单纯手术切除者为对照组(未栓塞组)。结果16例鼻咽部血管纤维瘤病人经血管造影检查均能获得明确诊断,并能显示病变的范围、血供情况及其特征。所有病例均主要由同侧的颌内动脉供血,对侧颌内动脉参与供血者5例,咽升动脉3 例,同侧颈内动脉2例。经超选择性插管后,所有病人均用聚乙烯醇泡沫微粒(PVA颗粒)和明胶海绵行颌内动脉双重栓塞,栓塞后即刻造影见肿瘤染色基本消失者10例,大部分消失者6例。该16例病人(栓塞组)手术切除术中出血量平均(452±268)ml较对照组(未栓塞组)平均(1058±347)ml明显减少(P<0.05)。所有病例栓塞术中均无严重并发症发生,手术切除术后未见复发。结论血管造影有利于术前明确鼻咽部血管纤维瘤的诊断和显示瘤体的血供,术前血管内栓塞有利于减少术中的出血量。Objective To explore the value of angiographic diagnosis and the preoperative embolization of nasopharyngeal agiofibromas. Methods Sixteen patients with nsopharyngeal agiofibromas (16 men; aged 9-21; average age, (13.5)±4) undergoing selective angiography and double embolization were analyzed retrospectively. Seldinger′s technique was used to catheterize patients; and 11 patients (instead of emboligation only with simple operative resection) were selected as control group. Results Of the 16 patients who underwent selective angiography of the left and right external carotid artery, obtained the correct diagnoses. The extent of lesion, the amount of vascularity and the nature of the feeding vessels were defined in the all cases. The nasopharyngeal angiofibroma was supplied by the ipsilateral internal maxillary artery mainly, contralateral internal maxillary artery in 5 cases, the ascending pharyngeal artery in 3 cases and the ipsilateral internal carotid artery in 2 cases. By superselective catheterization, the PVA (Polyvinyl Alcohol Foam) and Gelfoam were used for the embolzation of the internal maxillary artery through the double embolization. The tumor staining disappeared basicly after the supplying artery was embolized in 10 patients, and mostly disappearance was found in 6 patients. The bleeding significantly reduced during the operation in the all cases compared with the control group (452±268 ml vs 1058±347 ml, P<(0.05)). There were no severe complications during embolization and no recurrence after the operation. Conclusion The selective arteriography is of value to confirm the diagnosis and the supplying arteries of the tumor. The preoperative embolization can significantly reduce the amount of bleeding during the operation.

关 键 词：血管纤维瘤 鼻咽肿瘤 血管造影 栓塞 治疗性 

分 类 号：R732.2[医药卫生—肿瘤] R739.63[医药卫生—临床医学]