影像导航引导鼻内镜下切除鼻颅底骨化纤维瘤  

Endoscopic surgery for juvenile psammomatoid ossifying fibroma involved rhinosinus and cranial base with image guidance system

作　　者：王明婕[1] 周兵[1] 崔顺九[1] 黄谦[1] 李云川[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),北京100730

出　　处：《中国耳鼻咽喉头颈外科》2011年第3期141-144,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：北京市卫生系统高层次人才专项经费资助(2009-3-36)

摘　　要：目的探讨影像导航引导鼻内镜切除累及前颅底及眶纸板的青少年骨化纤维瘤(juvenile psammomatoid ossifying fibroma,JPOF)的可行性、关键技术和随访疗效。方法回顾性分析2004年5月～2008年9月收治的6例JPOF,对其临床表现、影像学特点、手术方式及术后并发症、随访结果等临床资料进行总结分析。结果 6例患者均为男性,年龄7～14岁,平均11.2岁。主要临床表现是眼球渐进性凸出。肿瘤最大直径3.0～5.0cm,平均3.7cm,病变累及筛窦、上颌窦、蝶窦、前颅底、眶纸板。所有患者均有前颅底和眶纸板受累。6例患者均采用影像导航引导鼻内镜下切除肿瘤,肿瘤实现彻底切除,无颅底及眶内并发症。随访20个月～6年,平均28.2个月。1例患者在术后15个月局部复发,其余5例患者无复发。结论影像导航引导鼻内镜下切除累及前颅底、眶纸板的鼻窦JPOF具有安全可行、并发症少的优势。OBJECTIVE To study the key technique and efficacy of endoscopic surgery with image guidance system（IGS）in the management of juvenile psammomatoid ossifying fibroma（JPOF）involving anterior skull base and orbit.METHODS We retrospectively reviewed the clinical presentations,surgical procedures and complications of 6 patients with JPOF who were treated by endoscopic approach with IGS from May 2004 to September 2008.All patients were followed by endoscopy and CT imaging evaluations.RESULTS All of the 6 cases were boys with a mean age of 11.2 years （range 7-14 years）.Painless bulging eyeball was the most common symptoms.The size of mass in paranasal sinus was ranged from 3.0 cm to 5.0cm in greatest dimension（mean 3.7 cm）and the medial orbital wall and cranial base were involved in all patients.An image guidance system was used to help to complete resection of the mass by endoscopic surgery effectively.All of the 6 patients received successful operation and relieved from symptom without mortality and major complications. During follow-up（ranged from 20 months to 6 years; mean follow-up 28.2 months）,only one patient was recurrent in local position.CONCLUSION The endoscopic approach with IGS is a safe and effective technique for JPOF involving anterior skull base and orbital wall with minimal morbidity and recurrence.During follow-up,CT scan should be examined regularly to find the recurrence as early as possible.

关 键 词：纤维瘤 骨化性 青少年 外科手术 计算机辅助 内窥镜检查 

分 类 号：R739.6[医药卫生—肿瘤]