鼻咽纤维血管瘤不同手术径路及疗效分析

Different surgical approaches for juvenile nasopharyngeal angiofibroma and analysis on their efficacy

目的探讨Ⅰ期和Ⅱ期鼻咽纤维血管瘤(juvenile nasopharyngeal angiofibroma,JNA)手术方式,并探讨鼻内窥镜手术的作用和局限性。方法回顾性分析陆军军医大学第一附属医院2002-2018年收治的20例JNA患者传统手术和鼻内镜手术资料,传统手术方式组9例(5例面中部掀翻进路途径,4例经硬腭进路),采用鼻内镜下肿瘤切除组11例。分析患者手术方式的选择、术中出血量、手术时间、术后住院时间、并发症的发生、复发和随访情况。结果所有患者病理学确诊为鼻咽血管纤维瘤,均为青少年男性,平均年龄14.6岁。与传统手术相比,经鼻内镜手术术中出血量少(509 mL vs 1072 mL),手术时间短(135 min vs 283 min),术后住院时间短(5.5 d vs 10.8 d),复发例数少(0 vs 2例)。结论经鼻内镜入路是处理JNAs的有效手术方式,具有创伤较小、出血量少、复发率低、住院天数少等优点。栓塞后的内镜手术是治疗中小型JNA的理想方法,对于较高分期JNA患者,可考虑鼻内镜联合鼻外径路入路。

Objective To investigate how to choose surgical approaches for juvenile nasopharyngeal angiofibroma(JNA)at stagesⅠandⅡ,and explore the function and limitation of endoscopic surgery.Methods Clinical data of 20 JNA patients undergoing conventional or endoscopic surgeries in the First Affiliated Hospital of the Army Medical University between January 2002 and December 2018 were collected and retrospectively analyzed.Of them,9 patients(open surgery group)were given conventional open surgeries(including 5 cases of facial degloving approach and 4 cases of transpalatal approach),and the other 11 patients(endoscopy group)were operated with the aid of endoscopy.The choice of surgical methods,intraoperative blood loss,length of hospitalization,incidence of complications and recurrence,and follow-up data were compared between the 2 groups.Results The enrolled patients were all males,at a mean age of 14.6 years,and pathologically diagnosed with NA.The endoscopy group had less intraoperative blood loss(509 vs 1072 mL),shorter operation time(135 vs 283 min),shorter length of hospital stay(5.5 vs 10.8 d)and lower recurrence rate(0/11 vs 2/9)when compared to the open surgery group.Conclusion Endoscopic surgery is a safe and reliable technique for JNA,with the advantages of milder traumatic injury,less blood loss,lower recurrence,and shorter hospital stay.Endoscopic surgery after embolization is an ideal method for the treatment of small and medium-sized JNA.For the patients with higher stages of JNA,nasal endoscopy combined with external nasal approach may be considered.