鼻咽血管纤维瘤手术治疗51例分析

目的比较鼻咽血管纤维瘤的治疗方法。分析各手术方式及术前超选择性动脉栓塞对不同分期患者治疗的优缺点。方法回顾性分析1989年2月—2004年10月51例鼻咽血管纤维瘤手术方式,采用Fisch分期,Ⅰ、Ⅱ期患者33例,经腭进路22例,鼻内镜手术11例;Ⅲ、Ⅳ期患者18例,经鼻侧切开9例,面中掀翻+LefortⅠ或同侧上颌骨拆装4例,颅面联合进路5例。51例患者中23例术前行超选择性瘤体供血动脉栓塞,其中Ⅳ期7例,Ⅲ期8例,Ⅱ期5例,Ⅰ期3例。结果术中平均出血量为1010ml,23例选择性瘤体供血血管栓塞患者,术中出血量200~870ml,平均485ml(x-±s,485ml±202ml);未栓塞组出血量500~3500ml平均1600ml(1600±757)ml,栓塞组平均出血量低于未栓塞组平均出血量(t=7·48,P<0·05)。术后1次复发8例,2次复发2例。术后复发时间平均为26·4个月(9~48个月)。结论术前行血管造影及血管栓塞对减少术中出血量具有临床意义。对于Ⅰ、Ⅱ期的患者,选择鼻内镜手术,可以避免传统手术创伤对患者术后颅面部生长发育的影响。对于Ⅲ、Ⅳ期患者,采用面中掀翻、LefortⅠ或同侧上颌骨拆装不仅有利于肿物的根治性切除,而且能够达到术后咬合关系影响小和美容佳的目的。

Analysis of surgical treatment of nasopharyngeal angiofibroma

OBJECTIVE: To study the individual surgical treatment of nasopharyngeal angiofibroma. METHODS: Between Feb. 1989 and Oct. 2004, different kinds of surgical approaches in 51 patients with angiofibromas were retrospectively analysed. Using Fisch stage: thirty three cases were in stage I and II, 22 cases via palatal approach, 11 cases via endoscopic surgery;18 cases were in stage IIN and IV, 9 cases via lateral rhinotomy approach, 4 cases via midfacial degloving approach + Lefort I approach or modified maxillotomy, 5 cases via craniofacial approach. Twenty three cases accepted the embolizion of the artery which feed the tumor, 7 cases in stage IV, 8 cases in stage IlI, 5 cases in stage II, 3 cases in stage I. RESULTS: The average of blood loss was 1010 ml in operation but it became 200 - 870 ml (the average of blood loss was 485 ml) when had a selective preoperative embolization. The blood loss of none selective preoperative embolization was 500 - 3500 ml (the average of blood loss was 1600 ml), t = 7. 48, P < 0.05, the average of blood loss of selective preoperative embolization is less than the average of blood loss of none selective preoperative embolization. After 9 to 48 months of operation (the average time was 26.4 months), 8 cases recurred one time and 2 cases recurred two times. CONCLUSIONS: The preoperative embolization could reduce the amount of bleeding during operation. In patients who are in stage I and II, searching endoscopic surgery could avoid the effect on craniofacial development which traditional surgical procedure did. For patient who are in stage III and IV, midfacial degloving approach and Lefort I approach or modified maxillotomy are not only good for exclusive resection of the tumor but also have less effect on articulation and beautiful cosmetic outlook.