鼻内镜下蝶腭动脉的电凝切断辅助超声刀切除鼻咽纤维血管瘤

Endoscopic resection of nasopharyngeal angiofibroma via ultrasonic knife technology assisted with electrocoagulation of sphenopalatine artery

目的探讨鼻内镜下蝶腭动脉的电凝切断辅助超声刀技术在鼻咽纤维血管瘤手术中的应用价值。方法回顾性分析2005年5月-2015年4月安徽医科大学第一附属医院耳鼻咽喉头颈外科收治的16例鼻咽纤维血管瘤患者的临床资料。均为青少年男性,所有患者手术前行数字减影血管造影（digital subtraction angiography,DSA）,其中9例行超选择性颈外动脉分支栓塞术,然后在内镜下切除肿瘤;另7例术前没有行选择性颈外动脉分支栓塞术患者直接行鼻内镜下电凝切断蝶腭动脉辅助超声刀技术切除肿瘤。比较两组手术时间、出血量、术后恢复时间、复发情况。结果两组手术时间、出血量、术后恢复时间比较,差异无统计学意义（P〉0.05）;术后随访1-10年,两组患者均无复发。鼻内镜下蝶腭动脉的电凝切断辅助超声刀技术切除鼻咽纤维血管瘤避免了术前DSA的并发症及手术风险。结论鼻内镜下蝶腭动脉的电凝切断辅助超声刀技术是鼻咽纤维血管瘤切除一种安全、微创、有效的手术方法。术前是否选择行超选择性颈外动脉分支栓塞术要根据肿瘤的位置和分期以及术者的临床操作水平。

Objective To explore the application value of ultrasonic knife technology assisted with electrocoagulation of sphenopalatine artery in nasopharyngeal angiofibroma surgery. Methods Clinical data of 16 patients suffering from nasopharyngeal angiofibroma surgically treated in our department from May 2005 to April 2015 were retrospectively analyzed. All patients were male adolescents and received preoperative digital subtraction angiography（ DSA）. Super-selective external carotid arterial embolization was adopted in 9 cases,and endoscopic removal of tumor was performed. In the 7 cases without preoperative embolization, endoscopic removal of tumor was finished using electrocoagulation of sphenopalatine artery and ultrasonic knife technology. Clinical data including operation time,amount of bleeding,postoperative recovery time,tumor relapse in both groups were recorded and analyzed. Results The differences of operation time,amount of bleeding and postoperative recovery time between the two groups were statistically insignificant（ all P〈 0. 05）. All patients were followed up for 1 to 10 years postoperatively,and no recurrence occurred.The resection of nasopharyngeal angiofibroma assisted with electrocoagulation of sphenopalatine artery and ultrasonic knife technology could avoid complications of preoperative DSA and surgical risk. Conclusion Ultrasonic knife technology assisted with electrocoagulation of sphenopalatine artery is a safe,minimally invasive and effective surgical method for nasopharyngeal angiofibroma. Whether to perform preoperative super-selective external carotid arterial embolization depends on the location and clinical stage of the tumor,and the operation level of surgeons.