鼻咽纤维血管瘤的诊断和治疗

Diagnosis and treatment of juvenile nasopharyngeal angiofibroma

分析我院21例鼻咽纤维血管瘤患者的临床治疗资料，鼻侧切开肿瘤切除5例，Fergusson切口肿瘤切除2例，经硬腭径路肿瘤切除15例。1例术后1年复发，再次经硬腭径路肿瘤切除。22次手术中术前行及未行IADSA和栓塞术的各11次。结果：术前未行和行IADSA和栓塞术的术中平均出血量和输血量分别为1136ml、836ml和677ml、400ml（P＜0．05）；Sessions分期和Chandler分期与术中出血量的相关系数分别为0．667和0.570，可见Sessions分期更切合实际。4例复发的患者经瘤体注射鱼肝油酸钠后肿瘤消失。结果说明鼻咽纤维血管瘤的手术采取何径路要根据肿瘤侵犯范围而定，术前IADSA加动脉内栓塞可大大减少术中出血；Sessions分期比Chandler分期更合理；复发的肿瘤可行瘤体内注射鱼肝油酸钠治疗。

The clinical data of 21 patients with juvenile nasopharyngeal angiofibroma were analysed. All patients underwent surgical excision of the neoplasma, 5 patients via lateral rhinotomy, 2 patients via transmaxillary approach with Fergusson incision, and 15 patients (16 operations) via transpalatal approach. Preoperative embolization reduced the blood loss from an average of 1 136 ml to 836 ml, and blood transfusion from an av-erage of 677 ml to 400 ml (P <0. 05). The correlation coefficient of Sessions staging system and blood loss at surgery was 0. 667, higher than that of Chandler staging sys-tem (0. 570). That indicated Sessions staging system is more practical. The preopera-tive IADSA (intraarterial digital subtraction angiography) and CT examination are nec-essary in eva1uation of the tumor blood supply and invasive extent, which is important in designing the operative approach. Intratumor injection of Sodium Morrhuate is an ef-fective method for management of early recurrent tumors.