鼻内窥镜引导下鼻咽血管纤维瘤切除术

Endoscopic nasal surgery in treatment of nasopharyngeal angiofibroma

目的鼻咽血管纤维瘤是一种较少见的难治性良性肿瘤，为避免常规手术的并发症，采用鼻内窥镜技术辅以动脉血管栓塞、控制性低血压麻醉等治疗８例。方法８例均为男性，平均年龄１６．６岁。全部患者术前均接受了ＣＴ和鼻内窥镜检查；６例在数字减影血管造影下进行了肿瘤供血动脉栓塞；７例全身麻醉术中采用了控制性低血压技术。结果全部患者无并发症；术中平均出血９００ｍｌ；８例平均随访８个月（１～２０个月），１例（１２．５％）术中未能完全切除。结论使用鼻内窥镜技术治疗鼻咽血管纤维瘤，并配合其他一些相关技术，对肿瘤局限在鼻腔、鼻咽腔、筛蝶窦和部分侵及翼腭窝的患者是适宜的。

Objective To avoid complications of the routine surgeries for nasopharyngeal angiofibroma.Metheds Endoscopic nasal surgery and other new techniques including controlled hypotention anesthesia and preoperative feeding artery embolism had been used. From April 1996 to September 1997 eight young male patients with diagnosis of nasopharyngeal angiofibroma were treated by endoscopic sinus surgery. The average age was 16.6 years old. Six accepted preoperative embolism,seven accepted hypotention anesthesia. Results No complications had occurred. Average intraoperative blood loss was 900 ml.All cases were followed for 1 to 20 months(mean 8 months ). Recurrence was found in only one patient three months after operation. The recurrent rate was 12.5%. Conclusion The lesions limited to nasal and nasopharyngeal cavitives and with sphnoid and ethmoid invasions can be removed by endoscopic nasal surgery. Endoscopic surgery has advantages in reducing complications and obtaining better post operative functions . Transnasal endoscopic examination is also necessary in the follow up period. Other techniques such as CT, digital substract angiography, preoperative feeding artery embolism and controlled hypotension technique during anesthesia are benefitcial.