婴幼儿鼻腔错构瘤的诊断及鼻内镜手术治疗

Diagnosis and endoscopic treatment of nasal hamartoma in infants

目的探讨婴幼儿鼻腔错构瘤的临床特点及诊疗措施。方法回顾性分析诊治的5例婴幼儿鼻腔错构瘤患者,分析其临床症状、局部体征、影像学表现及病理组织学特点,探讨其诊断、鉴别诊断及治疗策略。结果5例患儿均表现为单侧鼻腔阻塞,伴有不同程度的吃奶时呛咳、夜眠时打鼾憋气等现象。1例肿块在2个月内呈渐进性生长,4例肿块在病程中无明显增大。5例中有1例伴有同侧后鼻孔狭窄。影像学清晰显示鼻腔占位情况,2例位于单侧鼻腔、筛窦,3例累及单侧鼻腔、筛窦及鼻咽部;颅底骨质缺损3例,同侧眶壁骨质破坏2例;3例肿块内见斑点状、条状高密度钙化影,伴周围骨壁膨胀性改变;5例均有鼻中隔明显受压向对侧偏移。5例均采用鼻内镜下手术切除,4例完全切除,1例分3次切除,术后病理及免疫组化均提示鼻软骨间叶性错构瘤,随访至今均未复发。结论婴幼儿鼻腔错构瘤是一种非常罕见呈局限生长的瘤样增生,常以鼻塞为主要症状就诊。治疗以手术切除为主,鼻内镜手术一般可以完全切除大多数病变,并且具有视野清楚、创伤小、并发症少、术后恢复快等优点。

Objective To explore the clinical characteristics, diagnosis and treatment of infantile nasal hamartoma. Methods Clinical data including clinical symptoms, local signs, imaging manifestations, histopathological characteristics, diagnosis, differential diagnosis and treatment strategies of five infants with nasal hamartoma confirmed by pathology in our department were analyzed retrospectively. Results All patients showed unilateral nasal obstruction, accompanied by varying degrees of cough when feeding, snoring suffocation when sleep and so on. One patient showed progressive growth of tumor within two months, four of them showed no significant increase of tumor size. One patient had ipsilateral posterior nostril stenosis. Image examinations showed that tumors were located in unilateral nasal cavity and ethmoidal sinus in 2 cases, and unilateral nasal cavity, ethmoidal sinus and nasopharynx in 3. Three patients showed skull base bone defect, and two patients showed ipsilateral orbital wall bone destruction. Three of them showed spot-like, strip- like high-density calcification with expansion of the surrounding bone wall. Nasal septum was significantly compressed to contralateral nasal cavity in all patients. Four patients received complete removal and one with three times removals. No evidence of tumor recurrence was found during follow-up. Conclusions Infantile nasal hamartoma is a rare benign tumor of nasal cavity. The patients usually seek medical advice due to stuffy nose. Surgery is the mainstay of treatment modality for this tumor. With advantages of precise visualization, minimal invasion, few complication and rapid postoperative recovery, transnasal endoscopic technique is helpful in completely removing the nasal masses in most cases.