青少年鼻咽血管纤维瘤45例临床分析  

Clinical study of juvenile nasopharyngeal angiofibroma

作　　者：农东晓[1] 唐安州[1] 徐志文[1] 农辉图[1] 梁裕盛[2] 王大健[3] 黎燕宁[4] 

机构地区：[1]广西医科大学第一附属医院耳鼻咽喉科,南宁530021 [2]广西医科大学第一附属医院神经外科 [3]广西医科大学第一附属医院放射介入学科 [4]广西医科大学公共卫生学院卫生统计学教研室

出　　处：《临床耳鼻咽喉科杂志》2006年第2期70-72,共3页Journal of Clinical Otorhinolaryngology

基　　金：广西卫生厅基金资助项目(No:2001084)

摘　　要：目的：探讨如何减少青少年鼻咽血管纤维瘤（JNA）术中出血量，以及如何防止术后肿瘤复发的措施与方法。方法：回顾性分析我科1980年2月～2001年12月间收治的45例男性青少年JNA患者的临床资料，将45例患者分为两组，实验组包括术前行颈外动脉结扎患者10例，数字减影血管造影（（DSA）血管栓塞术8例；对照组为术前未作任何血管处理的患者（27例）。手术进路经传统或改良的腭问、鼻侧切开及颅面联合进路。术后放疗6例。结果：全部患者术后均随访6～84个月。治愈36例，复发9例，复发率为20．0％，其中有6例经再次手术完全切除肿瘤，3例未完全切除肿瘤，术后追加放疗，随访1～3年无复发。术前颈外动脉结扎、血管栓塞组的术中出血量与对照组比较无统计学意义。结论：①手术进路依肿瘤分期选择，绝大部分手术可经传统或改良的经腭及鼻侧切开进路完成；②术前颈外动脉结扎及血管栓塞组的术中出血量与对照组比较差异无统计学意义；③术中出血量、术后复发与肿瘤分期有关；④肿瘤残瘤复发及晚期患者采用放疗是有效的辅助疗法。Objective：To present our experiences of diagnosis and treatment for juvenile nasopharyngeal angiofibroma （JNA） and to evaluate the factors influencing intra-operative bleeding and tumor recurrence. Method：Forty-five patients suffered form JNA experienced surgical management and/or radiotherapy between January 1980 and December 2001 were studied retrospectively. All the patients were males. The age ranged from 13 to 24 years with mean of 16.3 years. Three operative approaches were selected according to tumor stage; the traditional and modified transpalatal, lateral rhinotomy and craniofacial combined approach. Six cases received postoperative ra diotherapy and 1 case received radiotherapy without surgery. Result： The tumors were completely resected in 36 cases and recurred in 9 cases （20%） during a follow-up period of 6 -84 months. Six of the 9 recurrent tumors were completely resected and the rest 3 were incompletely resected combined with postoperative radiotherapy, No recurrence was found in a follow-up period of 1-3 years. The tumor stage influences intraoperative bleeding and the incidence of recurrence, No statistically significance difference was found when comparing preoperative embolization of the vessels and ligature of the external carotid artery patients with non-embolized and control group （ P =0,554）, Conclusion;① With the approaches of operation selected according to tumor stage, most of the tumors can be removed by the traditional/modified transpalatal and lateral rhinotomy approaches; ② Preoperative ligature of the external carotid artery and embolization of the vessels feeding the tumor can not reduce intraoperative bleeding. The inconsistence of tumor staging in test and control groups may lead to this result; ③The tumors stage influcences the intraoperative bleeding and the incidence of recurrence; ④Radiotherapy is an effective adjuvant treatment for the patients with advanced stage or recurrent tumors.

关 键 词：鼻咽肿瘤 血管纤维瘤 青少年 

分 类 号：R739.63[医药卫生—肿瘤]