鼻内镜下鼻咽血管纤维瘤切除术及疗效随访  

Juvenile nasopharyngeal angiofibroma： endoscopic surgery and follow-up results

作　　者：周兵[1] 蔡葶[1] 黄谦[1] 梁熙虹[2] 倪鑫[1] 魏永祥[3] 崔顺九[1] 张罗[1] 王彤[1] 刘华超[1] 刘铭[1] 韩德民[1] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),100730 [2]首都医科大学附属北京同仁医院放射科(首都医科大学),100730 [3]首都医科大学附属朝阳医院耳鼻咽喉科

出　　处：《中华耳鼻咽喉头颈外科杂志》2010年第3期180-185,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨鼻内镜下鼻咽血管纤维瘤（juvenile nasopharyngeal angiofibroma，JNA）切除术手术方法的演变及疗效随访。方法回顾性分析2002-2009年入院接受经鼻内镜下切除术的59例JNA患者的病例资料。采用Radkowski分期系统，将Ⅰa～Ⅱb期分为A组，Ⅱe～Ⅲb期分为B组，观察记录术前分期、供血动脉、手术时间、出血量、术后残留或复发情况及其他术后并发症。结果A组21例，确诊年龄平均23．9岁，手术时间（106．0±43．7）min，出血量介于10～2000ml，中位数出血量为200ml；随访3～74个月（失访3例，中位随访时间36个月）。B组38例，确诊年龄平均16．2岁，手术时间（152．9±58．0）min，出血量介于100～7000ml，中位数出血量为400ml；随访3～87个月（失访5例，中位随访时间25个月）。随访期内A组无复发病例。B组1例患者行数字减影血管造影术后出现丘脑梗死，后痊愈，6例复发。两组手术时间和复发曲线的差异有统计学意义（t=-3．232，P=0．002；P=0．03）。结论鼻内镜下切除JNA时出血控制手段及强调瘤体附着骨组织的处理，以及采用切除部分或全部翼突及上颌窦后外侧壁，是切除肿瘤的关键；无翼肌间隙和颅底骨质受累的JNA（Radkowski分期Ⅰa～Ⅱb）效果良好，复发率低；Radkowski分期Ⅱc及以上的JNA有残留和复发的风险。Objective To present the changes of surgical approaches for the resection of juvenile nasopharyngeal angiofibromas （JNA） and the follow-up results. Methods The clinical records of 59 patients with JNA treated under endoscope between 2002 and 2009 were reviewed retrospectively. The patients were divided into two groups ： Group A （ Radkowski Ⅰ a- Ⅱ b） and Group B （ Radkowsik Ⅱ c- Ⅲb）. The tumor stages, feeding vessels, operating time, complications and recurrence were observed and recorded. Results There were 7 patients with stage Ⅰ a, 3 patients with stage Ⅰ b, 5 patients with stage II a, 6 patients with stage Ⅱ b, 4 patients with stage Ⅱ c, 23 patients with stage Ⅲ a, 11 patients with stage mb. The average age at diagnosis in Group A （21 cases） was 23.9 years old. The average operating time was （ 106. 0 ± 43.7 ） rain. The follow-up ranged from 3 months to 74 months （ median 36 months） except for 3 missing cases. The average age at diagnosis in Group B （38 cases） was 16. 2 years old and the average operating time was （ 152. 9 ± 58.0） rain. The follow-up ranged from 3 months to 87 months （ median 25 months） except for 5 missing cases. During follow-up, 6 patients in group B recurred. Infarction of thalamencephalon happened in 1 patient in group B who recovered totally afterwards. The difference in operating time between two groups was statistically significant （t = - 3. 232, P = 0. 002）. The life table was used to evaluate the survival curves and Log-rank test showed that the difference of recurrent time between two groups was statistically significant （ P = 0. 03 ）. Conclusions The key techniques to remove tumor are bleeding control, drilling-out the bone that tumor invaded. Transpterygoid or posterolateral wall of maxillary sinus approach are recommended for tumors that extend to infratemporal fossa. Small and intermediate-sized JNA which have no deep invasion of skull base （Radkowski Ⅰ a-Ⅱ b） have a low morbidity. JNA at Radkowski stage �

关 键 词：鼻咽肿瘤 血管纤维瘤 内窥镜检查 肿瘤复发 局部 预后 

分 类 号：R739.63[医药卫生—肿瘤]