鼻内镜下鼻咽纤维血管瘤切除术预后因素分析  

Analysis of prognostic factors in endoscopic surgery for juvenile nasopharyngeal angiofibroma

作　　者：蔡葶[1,2] 周兵[1] 黄谦[1] 梁熙虹[3] 倪鑫[1] 崔顺九[1] 李云川[1] 王彤[1] 臧洪瑞[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,北京100730 [2]徐州医学院附属医院耳鼻咽喉科 [3]首都医科大学附属北京同仁医院放射科,北京100730

出　　处：《临床耳鼻咽喉头颈外科杂志》2010年第22期1035-1039,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

基　　金：北京市卫生系统高层次人才专项经费资助(No:2009-3-36)

摘　　要：目的：分析影响鼻内镜下鼻咽纤维血管瘤（JNA）切除术预后的相关因素。方法：回顾性分析47例行鼻内镜下JNA切除术患者的病例资料,观察记录既往治疗情况、肿瘤累及范围、术前是否行血管栓塞、肿瘤供血动脉、手术步骤、随访时间及是否复发。选择既往手术史、颈内动脉系统分支供血、术前栓塞、翼突根海绵状骨受累、蝶骨大翼受累、翼肌间隙受累、颞下窝受累、眼眶受累等8项临床指标进行χ2检验单因素分析,探讨上述因素对复发是否存在影响。结果：47例患者均在全身麻醉下行鼻内镜下鼻咽纤维血管瘤切除术,随访12~87个月（中位随访期35个月）,随访期内共6例复发。χ2检验示翼突根海绵状骨受累与复发相关（P〈0.05）。既往手术史、颈内动脉系统分支供血、术前栓塞、颞下窝受累、眼眶受累、翼肌间隙受累、蝶骨大翼受累等因素与复发之间的相关性无统计学意义（P〉0.05）。影像学检查示复发位点位于翼突根附近。结论：翼突根海绵状骨受累与鼻内镜下JNA切除术后复发相关,在内镜手术及随访中应得到充分重视。Objective：Analyzing the prognostic factors in endoscopic surgery of juvenile nasopharyngeal angiofibromas（JNA）.Method：Forty-seven records of JNA,treated with the endoscopic,from 2002 to 2008 were reviewed retrospectively.Previous surgery in other hospitals,sites involved,whether selective embolization was performed before surgery,feeding vessels,operative techniques and follow-up results were recorded.Evaluated factors include previous surgery for resection of JNA,vascular supply from carotid artery,surgery after selective embolization,involvement of cavernous bone in the root of pterygoid process,greater wing of sphenoid bone,interpterygoid fossa,infratemporal fossa and orbit.Chi-square test was used.Result：Operations were done under general anesthesia.The follow-up time was 12 to 87 month（median 35 month）.During follow up,six patients presented recurrent lesions.Chi-square test showed that deep invasion of the cavernous bone in the root of pterygoid process was related to recurrence（P0.05）.There was no statistically significant difference between other factors and recurrence.Imaging examination showed that recurrent tumor was around the root of pterygoid process.Conclusion：Deep invasion of the cavernous bone in the root of pterygoid process which was related to recurrence deserve close attention before and after endoscopic surgery.

关 键 词：鼻咽纤维血管瘤 内镜检查 手术 复发 预后 

分 类 号：R766.3[医药卫生—耳鼻咽喉科]