内镜下鼻腔切割吸引器切除鼻咽血管纤维瘤21例临床分析

鼻咽血管纤维瘤是一种鼻咽部良性肿瘤,约占鼻咽部良性肿瘤的24.6%～40.0%,发病率居首位[1].目前治疗以手术为主,但因其瘤体部位深在,切除时暴露欠佳,手术时间长,易出血,手术难度较大.近年随着鼻内镜的临床应用及普及,运用鼻腔切割吸引器切除鼻咽血管纤维瘤成为可能,并已充分显示其优越性.我科自1997年10月～2003年9月收治的21例患者,运用内镜下鼻腔切割吸引器辅以圈套器切除肿瘤,均一次手术成功,随访无复发.现分析如下.     

鼻内镜下电动切割器切除鼻咽血管纤维瘤

目的 探讨鼻内镜下电动切割器切除鼻咽血管纤维瘤的临床效果。方法 对11例鼻咽血管纤维瘤病人，先行颈外动脉结扎术，再经鼻内镜应用电动切割器行血管瘤切除术。结果 11例均一次性手术成功。未见肿瘤残留。随访9个月至2年，未见复发，无严重并发症发生。结论 鼻内镜下电动切割器切除鼻咽血管纤维瘤是一种较好的方法。     

鼻内镜下电凝辅助等离子射频切除鼻咽血管纤维瘤

目的探讨鼻内镜下电凝辅助等离子射频切除鼻咽血管纤维瘤的应用。方法回顾性分析2008年1月～20011年12月诊治的5例鼻咽血管纤维瘤患者的临床资料,全部患者均在鼻内镜下行电凝辅助等离子射频切除术,观察术中平均出血量、术后恢复时间。结果本组病例肿瘤均一次性切除,平均出血量426 ml,无术后并发症,无残留;术后随访3个月,鼻内镜示术腔上皮化;随访1年,4例无复发,1例失访。结论鼻内镜下电凝辅助等离子射频切除局限于鼻腔鼻咽部的鼻咽血管纤维瘤是适宜的。     

数字减影血管造影及栓塞在鼻咽血管纤维瘤诊断和治疗中的应用

目的 探讨数字减影血管造影(DSA)及栓塞在鼻咽部血管纤维瘤诊断和治疗中的价值.方法 对16例鼻咽部血管纤维瘤进行DSA检查和选择性栓塞肿瘤供血动脉.栓塞后2～7天行鼻内镜下肿瘤切除.结果 DSA检查使鼻咽血管纤维瘤获得明确的诊断,所有病例均主要由同侧的颌内动脉供血,咽升动脉参与供血1例,同侧颈内动脉参与供血1例,16例患者均栓塞成功.鼻内镜下肿瘤全切除者15例,大部分切除者1例,术中出血明显减少,术中及术后无严重并发症.结论 鼻咽血管纤维瘤的数字减影血管造影能显示病变的范围、血供情况及其特征.栓塞有助于减少术中出血,提高手术安全性及全切率,为内镜下手术的必备条件.     

不同临床时期鼻咽血管纤维瘤的手术方式选择

目的探讨如何选择恰当的手术方式切除不同临床时期的鼻咽血管纤维瘤。方法2003年6月—2006年7月中南大学湘雅医院耳鼻咽喉科手术治疗的22例鼻咽血管纤维瘤，患者均为男性，年龄9～30岁，中位年龄16岁。按鼻咽血管纤维瘤Fiseh分期，6例临床Ⅰ期患者采取单纯经鼻内镜下肿瘤切除；6例临床Ⅱ期和2例临床Ⅲ期患者采取内镜下经中鼻道上颌窦后壁入路切除肿瘤；3例临床Ⅲ期和2例临床Ⅳ期患者采取内镜下经中鼻道一下鼻道扩大上颌窦后壁入路切除肿瘤；1例Ⅳ期患者采取显微镜下经耳前颞下窝入路联合内镜下经中鼻道．下鼻道扩大上颌窦后壁入路切除肿瘤；2例Ⅳ期患者采取鼻外上颌骨入路切除肿瘤。结果21例患者肿瘤全切，1例肿瘤次全切除，术后9个月再次经鼻内镜手术全切肿瘤残灶。无手术并发症，术后随访9个月至3年无复发病例。结论以鼻咽血管纤维瘤的临床分期为基础，分别以肿瘤是否占据整个鼻腔、是否达颞下窝外侧区及是否侵入颅内为依据，选择恰当的手术方式，对减少手术损伤，提高手术疗效具有重要意义。     

鼻内镜辅助超声刀鼻咽血管纤维瘤切除手术

目的探讨从鼻腔径路鼻咽血管纤维瘤超声刀切除术减少术中出血的可行性。方法14例鼻咽血管纤维瘤患者，行同侧主供血动脉DSA栓塞后经传统硬腭径路手术7例，鼻内镜下辅以鼻腔径路超声刀手术7例，比较两组患者的出血量、手术时间等指标。结果传统手术术中出血约700-1200ml，平均860ml，手术时间180-300min；鼻内镜下辅以鼻腔径路超声刀手术术中出血约250-350ml，平均293ml，手术时间90-180min，组间差异有统计学意义（均P〈0．001）。结论鼻内镜下辅以腔径路超声刀手术，是有效切除鼻咽血管纤维瘤的安全术式，能明显减少术中出血，缩短手术时间，降低术后复发率。     

鼻内镜微创手术治疗鼻颅底肿瘤36例临床分析

目的 探讨鼻内镜微创外科技术应用于鼻颅底肿瘤的适应证、疗效及安全性.方法 回顾性分析2000年1月至2004年6月鼻内镜下行鼻颅底肿瘤切除术36例,其中鼻咽血管纤维瘤16例、鼻窦骨化纤维瘤8例、垂体瘤8例、嗅神经母细胞瘤4例.患者术后均行病理检查证实.鼻咽血管纤维瘤患者术前行供血动脉介入栓塞术;嗅神经母细胞瘤患者术后给予放疗;2例较大的垂体瘤患者手术未能完全切除,术后给予放疗.结果 36例患者均行肿瘤全部或者大部分切除.3例患者出现脑脊液鼻漏并发症,其中2例分别采用中鼻甲黏膜和肌肉组织修补成功,另1例仪给予降颅压、抗炎处理后自愈.术后随访4～8年均无复发.结论 在正确选择适应证的前提下,鼻内镜微创手术能够安全有效地处理鼻颅底肿瘤.     

鼻内镜下经口径路腺样体微创切除术

目的探讨鼻内镜下经口径路切除腺样体的方法及疗效。方法对98例确诊为腺样体肥大患者应用电动切割吸引器在70°鼻内镜引导下经口腔切除腺样体,同时常规方法切除扁桃体81例,鼓膜置管4例（4耳）。结果术后随访3～6个月,夜间鼾声、呼吸睡眠暂停、睡眠中气喘或窒息、因鼻塞而张口呼吸,听力下降等症状恢复满意,鼻内镜或纤维鼻咽镜检查腺样体无残留,无并发症。结论电动切割吸引器鼻内镜下经口径路切除腺样体,术野清晰,切除范围准确,创伤小,手术彻底无残留,疗效肯定。     

鼻内镜下切除鼻咽血管纤维瘤临床探讨

青少年鼻咽血管纤维瘤(juvenile nasopharyngeal angiofibroma,JNA)的起源部位深在、血管供血丰富、周围解剖关系复杂,一度被视为鼻内镜手术的禁忌.而随着鼻内镜外科技术的成熟和影像介入技术的广泛开展,鼻内镜下切除鼻咽血管纤维瘤已经取得了一些成功经验[1,2].自2004年6月～2006年2月我科开展4例经鼻内镜鼻咽血管纤维瘤切除手术,获得满意疗效,现报道如下.     

儿童颅底肿瘤经鼻内镜外科手术治疗分析

摘要：目的探讨分析鼻内镜手术在治疗儿童颅底肿瘤中的应用。 方法回顾性分析中南大学湘雅医院鼻颅底外科 2010年6月—2019年11月收治确诊为颅底肿瘤并行鼻内镜治疗的患儿共44例,其中鼻咽纤维血管瘤17例,朗格汉斯组织细胞增生症7例,骨化纤维瘤5例,原始神经外胚层肿瘤2例,横纹肌肉瘤2例,脑膜瘤2例,间叶性软骨错构瘤1例,颅咽管瘤1例,表皮样囊肿1例,血管纤维脂肪瘤1例,生殖细胞瘤1例,骨母细胞瘤1例,脊索瘤1例,侵袭性垂体腺瘤1例,纤维瘤病1例。 结果44例患儿中43例在鼻内镜下完全切除,仅1例鼻咽纤维血管瘤分期切除。术后44例均进行定期随访,随访时间3个月至9年。5例失访,其中骨母细胞瘤1例,脑膜瘤1例,横纹肌肉瘤1例,鼻咽纤维血管瘤2例;12例术后接受放化疗,其中朗格汉斯组织细胞增生症7例,原始神经外胚层肿瘤 2例,横纹肌肉瘤1例,脊索瘤1例,生殖细胞瘤1例,随访至今患儿状况良好,均无复发及转移;1例鼻咽纤维血管瘤复发;再次手术后治愈;其余26例患儿术后未见复发。结论鼻内镜颅底手术治疗儿童颅底肿瘤是可行、有效及安全的。     

Recent advances in the treatment of juvenile angiofibroma

PURPOSE OF REVIEW: Juvenile nasopharyngeal angiofibroma is a rare vascular tumor almost exclusive to the nasopharynx of adolescent males. Traditionally, juvenile nasopharyngeal angiofibroma has been treated surgically using open surgical approaches and has been associated with frustratingly high recurrence rates. This article reviews recent contributions to the study and treatment of this disease. In particular, advances in minimally invasive endoscopic resection of juvenile nasopharyngeal angiofibroma are evaluated. RECENT FINDINGS: The growth patterns of juvenile nasopharyngeal angiofibroma are evaluated. Young age does not appear to correlate with more aggressive disease. The major recent advance in the treatment of juvenile nasopharyngeal angiofibroma has been the application of endoscopic endonasal surgery to the treatment of select tumors. This article reviews the indications and inclusion criteria recently put forth to help select patients for this minimally invasive approach. In properly selected patients with Radkowski stage I and II lesions, recurrence rates range between 0 and 7%. Advanced lesions continue, in most cases, to require open approaches, some of which are also presented. SUMMARY: With proper patient selection, endoscopic resection of juvenile nasopharyngeal angiofibroma is feasible and may be preferable to traditional open approaches. Results suggest that after endonasal resection, disease recurrence is low. Most larger lesions, especially those with intracranial spread, continue to require open approaches for complete resection.     

Endoscopic resection of nasopharyngeal angiofibromas by combined transnasal and transoral routes

PURPOSE: To determine the role of endoscopic surgery in decreasing intraoperative bleeding, morbidity, and hospitalization period of juvenile nasopharyngeal angiofibroma resection and to describe combined endoscopic transnasal and transoral approaches. PATIENTS AND METHODS: Twelve cases of juvenile nasopharyngeal angiofibroma diagnosed by endoscopic examination, computed tomography, and angiography were selected for endoscopic resection. Tumor staging ranged from stage I(A) to II(B). Ten patients underwent preoperative selective arterial embolization, and in 1 case selective arterial ligation was used. In general, the tumors were approached endoscopically through nasal and oral cavities with 0 degrees and 30 degrees 4-mm telescopes without any incision and no packing at their termination. RESULTS: The patients were followed by endoscopy and computed tomography. There was a dramatic decrease in intraoperative bleeding and postoperative morbidity. No early postoperative complications were seen. Two recurrences were observed in 12 patients up to a mean follow-up of 15 months. CONCLUSIONS: Minimal bleeding, decreased morbidity, and shorter hospitalization period were the main reasons that prompted us to use endoscopic technique for the removal of juvenile nasopharyngeal angiofibroma. Adding transoral endoscopic approach to the transnasal endoscopic approach provides 2-sided exposure and appreciate access to angiofibroma.     

Analysis of factors in successful nasal endoscopic resection of nasopharyngeal angiofibroma

Conclusions: Endoscopic resection of nasopharyngeal angiofibroma is less traumatic, causes less bleeding, and provides a good curative effect. Using pre-operative embolization and controlled hypotension, reasonable surgical strategies and techniques lead to successful resection tumors of a maximum Andrews-Fisch classification stage of III. Objective: To investigate surgical indications, methods, surgical technique, and curative effects of transnasal endoscopic resection of nasopharyngeal angiofibroma, this study evaluated factors that improve diagnosis and treatment, prevent large intra-operative blood loss and residual tumor, and increase the cure rate. Methods: A retrospective analysis was performed of the clinical data and treatment programs of 23 patients with nasopharyngeal angiofibroma who underwent endoscopic resection with pre-operative embolization and controlled hypotension. The surgical method applied was based on the size of tumor and extent of invasion. Curative effects were observed. Results: No intra-operative or perioperative complications were observed in 22 patients. Upon removal of nasal packing material 3–7 days post-operatively, one patient experienced heavy bleeding of the nasopharyngeal wound, which was treated compression hemostasis using post-nasal packing. Twenty-three patients were followed up for 6–60 months. Twenty-two patients experienced cure; one patient experienced recurrence 10 months post-operatively, and repeat nasal endoscopic surgery was performed and resulted in cure.     

鼻内窥镜引导下鼻咽血管纤维瘤切除术

目的 鼻咽血管纤维瘤是一种较少见的难治性良性肿瘤，为避免常规手术的并发症，采用鼻内窥镜技术辅以动脉血管栓塞，控制性低血压麻醉等治疗８例，方法 ８例均为男性，平均年龄１６．６岁，全部患者术前均接受了ＣＴ和鼻内窥镜检查；６例在数字减影血管造影下进行了肿瘤供血动脉栓塞；７例全身麻醉术中采用了控制性低血压技术。结果 全部患者无并发症；术中平均出血９００ｍＬ；８例平均随访８个月（１￣２０个月）、１例（１２．     

Endoscopic sinus surgery for juvenile nasopharyngeal angiofibroma

Juvenile nasopharyngeal angiofibroma is a rare tumour of the head and neck with very specific characteristics: adolescent males, choana-nasopharynx, pterygomaxillary fossa widening, specific and intense vascularisation. Staging is very important in the decision of the surgical approach. Endoscopic management of juvenile nasopharyngeal angiofibroma is technically possible after preoperative embolisation. Up to now 13 angiofibroma have been treated using the endonasal endoscopic sinus surgery approach in Belgium (Leuven 8; Mont-Godinne 2; Ghent 1; Liege 1; Woluwe 1). In smaller tumors endoscopic resection has been successful in four cases without any recurrence. Five larger tumors, extending in the pterygomaxillary fossa, were also successfully resected. Extension into the infratemporal fossa or the cavernous sinus can be endoscopically removed, but recurrences may occur as they do after classical, external approaches. In conclusion, the endoscopic approach is an acceptable alternative in small to middle sized juvenile nasopharyngeal angiofibroma.     

鼻内镜下低温等离子射频切除术治疗鼻咽血管纤维瘤的初步观察

目的 探讨鼻内镜下低温等离子射频切除术治疗鼻咽血管纤维瘤(nasopharyngeal angiofibroma,NA)的可行性.方法 回顾性分析2005年12月至2009年8月诊治的4例NA患者的临床资料,其中1例为Ⅰ期患者,3例为Ⅱ期患者,4例患者术前均行选择性动脉栓塞,采用控制性低血压全身麻醉,在鼻内镜下采用低温等离子射频刀完成肿瘤切除手术,双极电凝辅助止血.结果 4例患者肿瘤均彻底切除,手术时间分别为60、80、110、90 min,术中出血量分别为250、250、320、280 ml,所有患者术中、术后均未输血.术后随访6个月至4年,无并发症发生,肿瘤无复发.结论 鼻内镜下低温等离子射频切除手术治疗Ⅰ期及Ⅱ期NA患者,具有出血量少、肿瘤切除彻底等优点,是一种微创的手术治疗方法.     

鼻内镜下蝶腭动脉的电凝切断辅助超声刀切除鼻咽纤维血管瘤

摘要：目的探讨鼻内镜下蝶腭动脉的电凝切断辅助超声刀技术在鼻咽纤维血管瘤手术中的应用价值。方法回顾性分析2005年5月~2015年4月安徽医科大学第一附属医院耳鼻咽喉头颈外科收治的16例鼻咽纤维血管瘤患者的临床资料。均为青少年男性,所有患者手术前行数字减影血管造影(digital subtraction angiography, DSA）,其中9例行超选择性颈外动脉分支栓塞术,然后在内镜下切除肿瘤;另7例术前没有行选择性颈外动脉分支栓塞术患者直接行鼻内镜下电凝切断蝶腭动脉辅助超声刀技术切除肿瘤。比较两组手术时间、出血量、术后恢复时间、复发情况。结果两组手术时间、出血量、术后恢复时间比较,差异无统计学意义（P>0.05）;术后随访1～10年,两组患者均无复发。鼻内镜下蝶腭动脉的电凝切断辅助超声刀技术切除鼻咽纤维血管瘤避免了术前DSA的并发症及手术风险。结论鼻内镜下蝶腭动脉的电凝切断辅助超声刀技术是鼻咽纤维血管瘤切除一种安全、微创、有效的手术方法。术前是否选择行超选择性颈外动脉分支栓塞术要根据肿瘤的位置和分期以及术者的临床操作水平。     

Endoscopic vs. open surgery for treating large, locally advanced juvenile angiofibromas: a comparison of local control and morbidity outcomes

Juvenile nasopharyngeal angiofibroma is a combined vascular and fibrous neoplasm that most commonly affects prepubertal and adolescent boys. These tumors have traditionally been managed with open surgery, but interest in endoscopic resection-particularly for small tumors-has increased in recent years. To the best of our knowledge, no comparative study of open and endoscopic approaches for treating large, locally advanced tumors has been previously published in the literature. We conducted a retrospective study of 42 males, aged 6 to 21 years (mean: 13 ± 2.1), who had been treated for histologically proven and locally advanced juvenile nasopharyngeal angiofibroma with either open surgery (n = 29) or endoscopic excision (n = 13). Our two primary outcomes measures were local control and surgical morbidity. We found that the endoscopic approach was as good as or better than open approaches for patients with large tumors.