鼻咽部血管纤维瘤血管造影及术前栓塞

Angiography and preoperative embolization of nasopharyngeal agiofibromas

目的探讨鼻咽部血管纤维瘤的血管造影诊断和术前栓塞治疗价值。方法回顾性分析16例鼻咽部血管纤维瘤的血管造影及术前栓塞治疗资料。结果血管造影检查均能获得明确的诊断,并能显示病变的范围、血供情况及其特征。所有病例主要由同侧的颌内动脉供血,对侧颌内动脉参与供血者5例,咽升动脉3例,同侧颈内动脉2例。用聚乙烯醇泡沫(polyvinylalcoholfoam,PAF)颗粒和明胶海绵行颌内动脉双重栓塞,栓塞后即刻造影见肿瘤染色基本消失者10例,大部分消失者6例。该16例患者手术切除术中出血量(平均452±268)ml较对照组(平均1058±347)ml明显减少(P<0.05)。结论血管造影有利于明确鼻咽部血管纤维瘤的诊断,术前血管内栓塞有利于减少术中的出血量。

OBJECTIVE To evaluate angiogra- phy in angiofibroma diagnosis and effect of preop- erative embolization of nasopharyngeal agiofibromas. METHODS Data of 16 patients with nasopharyngeal agiofibromas (16 males; aged 9 to 21 years old; aver- age age, 13.5 ± 4 years old), who had undergone se- lective angiography and double embolization, were ana- lyzed retrospectively. RESULTS Of the 16 patients who underwent selective angiography of the left and right external carotid arteries, all of them were diag- nosed correctly. The extent of lesion, the amount of vascula-rity and the nature of the feeding vessels were defined in all cases. The nasopharyngeal angiofibroma was mainly supplied by the ipsilateral internal maxil- lary artery, 5 cases also by contralateral internal max- illary artery, 3 cases by ascending pharyngeal artery too, and 2 cases also by ipsilateral internal carotid artery. With superselective catheterization, the polyvi- nyl alcohol foam (PAF) and gelfoam were used for double embolzation of the internal maxillary artery. The tumor staining almost disappeared completely after the sup- plying arteries were embolized in 10 patients, and mostly disappeared in 6 patients. Blood loss were sig- nificantly reduced during operations in all cases com- pared with control group(452 ± 268 ml vs 1 058 ± 347 ml, P < 0.05). There were no severe complications in- curred during embolizations and no recurrences after operations. CONCLUSION The selective arteriogra- phy is a valuable technique to diagnose angiofobroma and to get detailed image of supplying arteries of the tumor. Preoperative embolization can significantly reduce blood loss during operation. [