鼻内镜下青少年鼻咽纤维血管瘤切除术15例报告

Nasal Endoscopic Resection for Advanced Juvenile Nasopharyngeal Angiofibroma: Report of 15 Cases

目的探讨鼻内镜下切除青少年鼻咽纤维血管瘤的操作技巧。方法 2004年7月~2010年12月,对15例鼻咽纤维血管瘤（Chandler分期Ⅲ期9例,Ⅱ期6例）行鼻内镜或鼻内镜联合柯陆氏入路鼻咽纤维血管瘤切除术,手术在术前栓塞和术中控制性降压基础上进行,视肿瘤大小及侵及范围的不同采用不同的手术方法。结果 11例行单纯鼻内镜手术,4例行鼻内镜联合柯陆氏入路手术。无术中及围手术期并发症发生。术后72 h分次撤出前鼻孔填塞。术后住院3~5 d,平均3.4 d。15例随访11~77个月,平均39.7月,除1例复发,其余均未发现肿物残留及复发,术腔上皮化良好,术后鼻腔功能基本正常。结论在术前栓塞和术中控制性降压基础上,合理的手术策略和技巧是鼻内镜下ChandlerⅢ期及以下的肿瘤切除成功的保证。

Objective To investigate the surgical skills of endoscopic resection of juvenile nasopharyngeal angiofibroma（JNA）. Methods Retrospective review was made on 15 patients with JNA（9 cases of Chandler stage Ⅲ and 6 cases of stage Ⅱ）,who were treated by endoscopic surgery from July 2004 to December 2010.With preoperative occlusion and intraoperative blood pressure control,we carried out single endoscopy or endoscopy combined with Caldwell-Luc incision to resect the tumor.Surgical approach was determined by the size and extension of the tumor. Results Four patients received Caldwell-Luc incision,the other 11 patients underwent endoscopy only.No peri-operative complications occurred.Nasal stuff was removed in 72 hours after the operation.The patients were discharged from hospital in 3 to 5 days postoperation with a mean of 3.4 days.Follow-up was available in all the patients for 11 to 77 months（mean,39.7 months）.During the period only one recurrent case was detected,no residual tumor was found in the patients,all the patients showed well epithelized operative cavities and normal nasal function. Conclusion With preoperative occlusion and intraoperative blood pressure control,rational surgical approach and techniques are the keys to endoscopic resection of JNA.