鼻咽纤维血管瘤22例手术分析

目的：探讨鼻咽纤维血管瘤的手术方法。方法：22例鼻咽纤维血管瘤患者均行手术治疗,其中经腭径路12例,经鼻腔径路5例（鼻侧切开2例,梨状孔径路2例,经前鼻孔径路1例）,经口腔口咽径路2例,硬腭-唇龈径路2例,鼻-硬腭径路1例。结果：术中出血量最多1600ml,最少400ml。1例复发,其余21例随访1～2年无复发。结论：做好术前准备、选择适当的手术径路及采取颈外动脉结扎或数字减影血管栓塞术对防止复发、减少术中出血和完整切除肿瘤最为关键。     

Review of nasopharyngeal carcinoma

We review the literature on nasopharyngeal carcinoma that has been published within the past 5 years. Nasopharyngeal carcinoma is a highly morbid disease, and survival is poor. Its management remains extremely difficult, not just for otolaryngologists but for radiation oncologists and medical oncologists, as well. A clear understanding of its etiology is still lacking, but nasopharyngeal carcinoma is widely suspected to be the result of both a genetic susceptibility and exposure to environmental factors or Epstein-Barr virus infection. With no clear cause, treatment is controversial. For example, an optimal radiation regimen has not been determined, reports in the literature regarding the role of chemotherapy for advanced disease are conflicting, and treatment of local recurrences is unsettled. Still, advances in immunologic research and chemotherapy offer hope for better control of the disease. We hope that our assessment of the recent literature will provide otolaryngologists with a more clear understanding of the etiology and management of nasopharyngeal carcinoma.     

Stenting the nasopharyngeal isthmus by nasopharyngeal airway after correction of acquired total nasopharyngeal obstruction: surgical procedure and results

The objective of this study is to describe a simple surgical procedure for management of acquired total nasopharyngeal obstruction in adults. Five patients were diagnosed as having complete nasopharyngeal obstruction over a 3-year period. Three patients previously underwent uvulopalatoplasty, while for the remaining two it was due to pharyngoscleroma. In all the patients, nasopharyngeal obstruction was at the level of the inferior edge of the soft palate. Two of the post-uvulopalatoplasty patients had recurrent obstruction after scar excision and topical application of mitomycin-C without stenting. All the patients were treated surgically by creation of a new anatomical nasopharyngeal isthmus and stenting it by nasopharyngeal airway for 6?months. All the patients experienced satisfactory results and good tolerability to airway placement. The nasopharyngeal airway can counteract the inevitable scar contraction of the new nasopharyngeal isthmus after surgical correction and maintain its patency.     

Radiology of nasopharyngeal carcinoma

Plain film radiography and pluridirectional tomography have been displaced by CT and MRI for imaging NPC. The latter techniques are to some extent complementary, since MRI is particularly useful for defining soft-tissue components and CT accurately delineates bone erosion. CT, however, also provides good soft-tissue definition in conjunction with contrast enhancement. Nuclear isotope scanning is valuable in detecting bone metastases. These imaging techniques are of particular value in detecting submucosal tumors not visible clinically and are also essential to accurate tumor staging.     

Diagnosis of nasopharyngeal carcinoma

The diagnosis of nasopharyngeal carcinoma rests on perceptive symptom analysis, a careful clinical examination, and the selection of appropriate clinical investigations. A high index of suspicion is required. When mirror examination fails to provide a satisfactory view of the nasopharynx, flexible or rigid nasopharyngeal endoscopy is mandatory. Serologic examination of IgA antibodies to Epstein-Barr virus early antigen and viral capsid antigen is helpful in identifying high-risk patients. Biopsy material should be sent fresh to the laboratory for analysis so that special staining can be carried out in cases of doubtful diagnosis.     

Child nasopharyngeal angiofibroma

Angiofibromas are benign tumors, highly vascularized, that affect male adolescents and young men. We present a clinical case of an 11-year-old patient with an angiofibroma of the nasopharynx, reviewing the etiopathogenic theories and current surgical approaches.     

Juvenile nasopharyngeal angiofibroma

Juvenile nasopharyngeal angiofibromas (JNAs) are rare, benign, highly vascular, locally aggressive tumors that primarily affect male adolescents. Historical treatment of these neoplasms has been primarily surgical. In the past decade, endoscopic resection of JNAs has become a viable and promising surgical treatment option. Endoscopic resection has many advantages over traditional open techniques, including better cosmesis, decreased blood loss, shortened hospital stays, and equivalent or improved recurrence rates. Emerging endoscopic technology continues to push the boundaries of resection of skull base tumors and will no doubt become the surgical treatment of choice for most JNAs in the near future.     

鼻咽癌放射治疗后鼻咽坏死60例临床分析

目的 探讨鼻咽癌放射治疗后鼻咽坏死的临床特点、诊断、治疗、预后及相关因素.方法 对60例诊断明确的鼻咽癌放疗后发生鼻咽坏死患者进行回顾性分析,男50例,女10例,年龄30 ～ 70岁,中位年龄51.5岁.所有患者均行纤维鼻咽镜下鼻咽坏死清创术,感染者配合全身或局部抗感染治疗.Kruskal-Wallis H检验分析鼻咽坏死发生距末次放射治疗结束的时间(放疗-坏死间隔时间)及治疗后疗效的相关因素;Cox比例风险回归模型评价预后风险因素.结果 放疗-坏死间隔时间为1 ～ 156个月,中位时间5个月;一程放疗组及多程(≥2)放疗组的放疗-坏死间隔中位时间分别为7.0和4.5个月,差异有统计学意义(X2=5.527,P=0.031);T2组和≥T3组的中位放疗-坏死间隔时间分别为7.5和5.0个月,差异有统计学意义(x2=4.330,P=0.037).鼻咽伴有感染者41例(68.3％),感染和未感染患者疗效差异有统计学意义(X2=14.775,P＜0.001).经纤维鼻咽镜下鼻咽清创术及全身或局部抗感染治疗后,全组患者症状均有不同程度缓解.随访2 ～ 46个月,中位数12.5个月,7例死于鼻咽大出血,15例死于肿瘤或系统衰竭,5例失访,其他均存活.Cox回归分析显示颈内动脉受侵显露是影响患者预后的独立危险因素(P＜0.05).结论 纤维鼻咽镜下鼻咽坏死清创术为一种有效的治疗手段,感染对鼻咽坏死的发生及疗效均有影响;放疗剂量、疗程及肿瘤分期是放疗后鼻咽坏死形成的重要因素,鼻咽坏死灶累及颈内动脉是影响预后的独立危险因素,鼻咽大出血及衰竭为主要死因.