经鼻腔内窥镜鼻咽纤维血管瘤切除术  

Trans-nasal endoscopic nasopharyngeal fibromectomy

作　　者：张洪[1] 张茜蕾 魏云[1] 李森[1] 钱江[1] 张正健[1] 徐群[1] 

机构地区：[1]四川省达州市第二人民医院耳鼻咽喉头颈外科,635000

出　　处：《齐齐哈尔医学院学报》2009年第2期142-143,共2页Journal of Qiqihar Medical University

摘　　要：目的为探索鼻咽纤维血管瘤的微创手术方法。方法2000年2月～2006年2月收治5例男性鼻咽纤维血管瘤患者,年龄15～21岁,经鼻腔、鼻咽和CT检查发现,肿瘤全部由鼻咽部侵入患侧鼻腔,2例侵入蝶窦。根据Chandler分期法均为Ⅱ期。5例患者采用全麻,先行患侧颈外动脉结扎,控制性低血压技术,再经鼻腔在鼻内窥镜引导下采用双极电凝、微波等进行骨膜外热凝分离切除,边切除边用去甲肾上腺素纱条紧紧填入创区压迫肿瘤,帮助止血。肿瘤基底的切除在骨膜下进行,切除的肿瘤大小4 cm×3 cm×2 cm～5 cm×4 cm×3 cm大小。手术出血200～400 ml。结果5例患者均于手术后7天出院,观察随访3～9年,无复发、鼻咽腔光滑、上皮化良好。结论经鼻腔内窥镜切除Ⅰ期Ⅱ期鼻咽纤维血管瘤是一种好的微创新方法。手术前应先行供血动脉阻断及运用控制性低血压技术,以减少出血。对Ⅲ期和Ⅳ期以上肿瘤应该限制使用这种方法。Objective To explore the minimally invasive surgical techniques of nasopharyngeal fibroangioma. Methods There were 5 male patients with nasopharyngeal fibroangioma aged between 15 and 21 years from February 2000 to February 2006. By examining nasal cavity and nasopharynx, and CT detection, it was seen that tumor invaded the nasal cavity of the affected side through pharynx nasalis in all the 5 patients, and invaded the sphenoid sinus in 2 patients. The 5 patients were all belonged to phase 11 according to Chandlar. The 5 patients underwent general anesthesia, and then external carotid artery of affected side was performed. Under techniques of controlled hypotension and the guidance of nasal endoscope, separation and resection were performed by bipolar coagulation, with homeostasis by adding noradrenaline gauze into operation area. Tumor basement resection was performed beneath the periosteurn. Excisional tumor was between 4 × 3 × 2 and 5 × 4 × 3 cm. Surgical hemorrhage was between 200 and 400 ml. Results The 5 patients were discharged from hospital 7 days after the operation, and followed up between 3 and 9 years. No recurrence occurred, nasopharyngeal cavity was smooth and epithelialization was good. Conclusions Trans- nasal endoscopic nasopharyngeal fibromectomy is a new kind of minimally invasive surgical technique for nasopharyngeal fibroangioma in phase Ⅰ and Ⅱ. In order to re duce bleeding, before operation, feeding artery should be blocked and the techniques of controlled hypo- tension should be performed. This method is not suitable to nasopharyngeal fibroangioma in phase Ⅲ and Ⅳ.

关 键 词：鼻咽肿瘤 血管纤维瘤 内窥镜检查 外科手术 

分 类 号：R739.63[医药卫生—肿瘤] R777.23[医药卫生—临床医学]