鼻咽血管纤维瘤的内镜分期标准探讨

目的探讨一种新的青少年鼻咽血管纤维瘤分期标准。该标准充分考虑了外科术式（鼻内镜），颅内侵犯的范围以及颈内动脉分支血管供应的范围、程度等。方法回顾性分析2005年3月至2011年10月收治的经鼻内镜手术治疗的鼻咽血管纤维瘤患者，综合考虑肿瘤侵犯颅底的范围以及肿瘤的供应血管密度进行分期，与现行其它鼻咽血管纤维瘤分期标准作比较。手术失血量、手术次数、肿瘤复发作为主要观察指标。结果74％的患者有颅底侵犯。51％的患者观察到颈外动脉分支栓塞后，残余的高密度血管供应均来自颈内动脉分支。这些栓塞后残余颈内动脉分支按密度归于Ⅳ期和Ⅴ期，决定了术中失血量多少，故Ⅳ期和Ⅴ期需联合其它手术方式，以避免病变残留或肿瘤复发。结论肿瘤大小和鼻窦受累对预测内镜手术彻底切除肿瘤影响较小。本文论述的青少年鼻咽血管纤维瘤分期标准主要包含两个因素：颅底扩展途径以及肿瘤供应血管分布情况，其决定了手术方式、路径。相较其它分期标准，本文分期标准更能准确预测治疗应对措施（手术失血量、是否变通手术方式）以及肿瘤复发情况。

Discussion on endoscopic staging system for juvenile nasopharyngeai angioflbroma

Objective To develop a new staging system for juvenile nasopharyngeal angiofibroma that reflects changes in surgical approaches （endonasal）, route of intracranial extension, and the extent of vascular supply from the internal carotid artery. Method Retrospective review was used to study the series cases. 35 patients had undergone endoscopic endonasal surgery for JNA, from 2005 to 2011. Patients were staged according to current systems and compared with a new staging system that also incorporated the route of skull base extension and tumor vascularity. Estimated blood loss, number of operations, and tumor recurrence as main outcome measures were observed. Results Skull base erosion was observed in 74% of cases. Following embolization of external carotid artery tributaries, residual vascularity from the internal carotid artery was seen in 51% of patients. Residual vascularity, classified as our stage Ⅳ and Ⅴ, was strongly correlated with blood loss, requirement for multiple procedures, and residual or recurrent tumor. Conclusion Tumor size and extent of sinus disease were less important in predicting complete tumor removal with endonasal surgical techniques. This staging system for JNA accounted for 2 important prognostic factors, route of cranial base extension, and vascularity, which were applicable to endoscopic or open approaches. Compared with other staging systems, this staging system provides a better prediction of immediate morbidity （including blood loss and need for multiple operations） and tumor recurrence.