鼻咽纤维血管瘤鼻内镜术前超选择性动脉血管内栓塞的探讨

目的探讨鼻咽纤维血管瘤术前栓塞及鼻内镜下手术的临床价值。方法8例鼻咽纤维血管瘤鼻内镜下手术切除均行动脉内数字减影血管造影术及栓塞,供血动脉主要为颈外动脉的颌内动脉或咽升动脉,栓塞物为明胶海绵颗粒或聚乙烯醇(PVA)颗粒。结果鼻咽纤维血管瘤栓塞后90%肿瘤血供完全消失,栓塞后手术中出血明显减少,栓塞后3～5d手术最为理想。结论鼻咽纤维血管瘤术前栓塞治疗可有效减少术前出血,对于Ⅰ～Ⅲ期病变,于栓塞术后再行鼻内镜直视下切除可获得较好的手术效果。

Super-selective artery embolization prior to endoscopic resection of nasopharyngeal angiofibroma

Objective To evaluate the use of super-selective artery embolization prior to endoscopic resection of juvenile nasopharyngeal angiofibroma （JNA）. Methods Intra-arterial digital subtraction angiography （IADSA） and selective artery embolization were performed in 8 cases of JNA before nasal endoscopic resection. The supplying arteries originated from the maxillary and the pharyngeal ascending branches arising from external carotid artery were embolized with gelatin sponge or PVA. Results Complete occlusion of blood supply to the lesion was seen in 90% of cases after embolization, with significantly less blood loss during the subsequent procedures. The optimal timing for the operation appeared to be 3-5 days after the embolization. Conclusion Preoperative artery emholization for juvenile nasopharyngeal angiobroma may result in less blood loss. Considerable outcomes for stages ｜ to llI lesions may be expected with selective artery embolization followed by endoscopic resection under direct vision.