鼻咽血管纤维瘤手术方式的探讨

An analysis of the surgical approaches to juvenile nasopharyngeal angiofibroma

目的 探讨鼻咽血管纤维瘤的术式选择及适应证。方法 对 1986年 4月～ 1999年 4月经病理证实的 16例病人临床资料进行回顾性分析。根据病变扩展范围分别采用经鼻内镜或手术显微镜下硬化剂注射加电灼及面中部翻揭 上颌窦联合径路切除肿瘤。结果 全部 16例经 2～ 14年随访 ,治愈率为 75 .0 %。复发 4例均为Ⅲ期肿瘤。术中出血量 ,经鼻径路均少于 10 0ml,经面中部翻揭 上颌窦联合径路切除平均为 15 5 0ml。结论 肿瘤术前分期是影响预后的关键因素 ,根据病变范围合理选择术式 ,对减少术中出血。

Objective To explore the optional surgical approaches adopted in patients with juvenile nasopharyngeal angiofibroma (JNA). Methods The clinical presentation, management, and prognosis of 16 patients with JNA were reviewed retrospectively from April 1986 to April 1999. The surgical techniques consisted of transnasal approach and transmaxillary via midfacial degloving. Results The cure rate was (75.0%) (12/16) with follow-up duration from 2 to 14 years. Tumor recurrence was seen in four patients at stage Ⅲ. Conclusion Surgery is the gold standard for treatment of JNA. The extent of preoperative tumor was found to be the primary factor influencing the surgical prognosis. This paper indicates that the surgical approach should be selected according to the tumor stage.