鼻咽纤维血管瘤术前动脉造影和栓塞的临床价值

目的探讨术前动脉造影和栓塞对鼻咽纤维血管瘤的治疗效果及临床价值。方法 74例鼻咽纤维血管瘤患者均行外科手术治疗,并依据Sessions分期及手术切除前是否进行动脉造影和介入栓塞分为4组,Ⅰ组9例SessionsⅠ期患者行术前栓塞和手术切除,Ⅱ组25例SessionsⅠ期患者行单纯手术切除,Ⅲ组23例SessionsⅡ、Ⅲ期患者行术前栓塞和手术切除,Ⅳ组17例SessionsⅡ、Ⅲ期患者行单纯手术切除;比较4组患者术中失血量、手术时间及术后住院时间。结果Ⅰ组患者血管造影显示栓塞后肿瘤血管完全阻断7例(77.8%),鼻咽纤维血管瘤被完全切除9例(100.0%);Ⅱ组患者鼻咽纤维血管瘤被完全切除25例(100.0%);Ⅰ组和Ⅱ组患者术中失血量(P=0.641)、手术时间(P=0.086)及术后住院时间(P=0.483)比较差异均无统计学意义。Ⅲ组患者血管造影显示肿瘤血管完全阻断12例(52.2%),鼻咽纤维血管瘤被完全切除21例(91.3%),大部切除2例(8.7%);Ⅳ组患者鼻咽纤维血管瘤被完全切除15例(88.2%),大部切除2例(11.8%);Ⅲ组患者术中失血量显著少于Ⅳ组,差异有统计学意义(P=0.019);但Ⅲ组和Ⅳ组患者手术时间(P=0.308)、术后住院时间(P=0.472)比较差异均无统计学意义。4组患者均无手术后死亡病例,栓塞过程中均无临床并发症出现。结论术前造影和栓塞能显著减少Ⅱ、Ⅲ期鼻咽纤维血管瘤术中失血量。

Clinical value of preoperative angiography and embolization on nasopharyngeal fibroangioma

Objective To study the effect and clinical value of preoperative angiography and embolization in patients with nasopharyngeal fibroangioma. Methods Seventy-four patients with nasopharyngeal fibroangioma who received surgery were divided into four groups according to the Sessions staging and whether they were performed with angiography and emboli- zation before the operation. Nine patients（ Sessions I ） in group I were performed with preoperative embolization and tumor- ectomy, twenty-five patients（ Sessions I ） in group II were performed with tumorectomy only, twenty-three patients （ Sessions II and III ） in group III received preoperative embolization and tumorectomy, seventeen patients （ Sessions II and III ） in group IV were performed with tumorectomy only. Intraoperative blood loss value, operation time and postoperative hospitalization time were compared in the four groups. Results In group I,angiography showed that the tumor vessels were completely blocked in 7 （77.8 % ） patients after the embolization, nasopharyngeal fibroangioma were totally resected in 9 （ 100.0% ） patients. In group II, nasopharyngeal fibroangioma were totally resected in 25 （ 100.0% ） patients. There was no significant difference in intraoperative blood loss value （ P = 0. 641 ）, operation time （ P = 0.086） and postoperative hospitalization time （ P = 0. 483 ） between group I and II. In group III, angiography showed that the tumor vessels were completely blocked in 12 （ 52.2% ） patients after the emboliza- tion ,nasopharyngeal fibroangioma were totally resected in 21 （91.3%） patients,subtotal nasopharyngeal fibroangioma were resec- ted in 2（8.7% ） patients. In group Iv,nasopharyngeal fibroangioma were totally resected in 15（88. 2% ） patients,subtotal naso- pharyngeal fibroangioma were resected in 2（ 11.8% ） patients. The intraoperative blood loss value in group IH was significantly less than that in group IV （P = 0. 019 ）. There was no significant difference in operation time （P = 0. 308 ） mad postoperative hospi-talization time （P = 0. 472） between group III and IV. There was no post-operative death in the four groups, and there was no clini- cal complication during the embolization. Conclusion Preoperative angiography and embolization can reduce the intraoperative blood loss value in patients with session II and III nasopharyngeal fibroangioma.