鼻咽血管纤维瘤不同手术径路及术中出血原因的探讨

目的：探讨3类鼻咽血管纤维圹、JNA）有效的术式和术中出血的原因。方法：回顾性分析36例JNA患者的临床资料。Ⅰ类肿瘤15例，采用鼻腔入路；Ⅱ类肿瘤18例，采用扩大的上颌窦根治术切口及上颌窦-颞下窝-鼻腔联合入路；Ⅲ类肿瘤3例，采用颅内外联合入路。结果：Ⅰ类肿瘤15例中有14例一次手术完全切除，术后无复发，1例术后复发经同样入路再次手术完全切除；Ⅱ类肿瘤18例中有13例一次切除术后无复发，5例术后复发经二次彻底切除；Ⅲ类肿瘤3例有分叶向颅内深入扩展，未能全切，颅内残余肿瘤补作约40Gy的放疗，效果良好。结论：采用以上3种手术方案可有效切除不同类型的JNA。颅内有残余肿瘤者可辅以放疗。在明视下细致分离肿瘤，妥善止血是手术成败的关键。

The reliable treatment choice of nasopharyngeal angiofibroma and causes of operative bleeding

Objective： To introduce the efficacy of three surgical options for juvenile nasopharyngeal angiofibroma（JNA） resection, and causes of operative bleeding. Method：Retrospective analysis of 36 JNAs,three surgical options were used to resect the tumor. There were 15 cases of Class Ⅰ tumors , using endoscopic nasal cavity approach. Eighteen cases of class Ⅱ tumors, via extended Caldwell-Luk incision, using the transantral-infratemporal fosse-nasal cavity combined approach for tumor resection. Three cases of class Ⅲ tumors, the combined intracranial and extra-cranial approach was used to resect the tumor. Meanwhile, report six typical cases for reference. Result：Fifteen （15/36） cases of class Ⅰ tumors , 14 cases were completely resected for the first time without recurrence, 1 recurrence case was re-resected using the same approach. Eighteen（18/36） cases of class Ⅱ tumors, 13 cases were completely resected for the first time without recurrence, 5 recurrence cases were re-resec- ted totally. Three （3/36） cases of class Ⅲ were not completely removed, and underwent about 40 Gy radiotherapy with good effects. Conclusion： Using these three surgical options can effectively remove different types of JNA. When necessary, the intracranial residue can use radiotherapy. Under direct vision to separate the tumor, and effective hemostasis play crucial roles for complete removal of the tumor.