鼻咽纤维血管瘤不同手术径路及疗效分析

顾翔; 袁琨; 郭蓓; 陈伟; 袁伟

doi:10.16016/j.1000-5404.202006207

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鼻咽纤维血管瘤不同手术径路及疗效分析

临床医学 | 更新时间：2026-01-09

- 鼻咽纤维血管瘤不同手术径路及疗效分析
- Different surgical approaches for juvenile nasopharyngeal angiofibroma and analysis on their efficacy
- 第三军医大学学报 2020年42卷第21期页码：2148-2153
- 作者机构：
  
  1.400038 重庆，陆军军医大学(第三军医大学)第一附属医院耳鼻咽喉头颈外科
  2.430000 武汉，华中科技大学同济医学院附属武汉市中心医院耳鼻咽喉头颈外科
- 作者简介：
  
  [袁伟，E-mail:weiyuan175@sina.com YUAN Wei; E-mail:weiyuan175@sina.com
- 基金信息：
- DOI：10.16016/j.1000-5404.202006207
  中图分类号： R730.26;R730.56;R739.63
- 收稿：2020-06-22，
  
  修回：2020-08-23，
  
  纸质出版：2020-11-15
- 稿件说明：
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顾翔, 袁琨, 郭蓓, 等. 鼻咽纤维血管瘤不同手术径路及疗效分析[J]. 第三军医大学学报, 2020,42(21):2148-2153.

Xiang GU, Kun YUAN, Bei GUO, et al. Different surgical approaches for juvenile nasopharyngeal angiofibroma and analysis on their efficacy[J]. Journal of Third Military Medical University, 2020, 42(21): 2148-2153.
顾翔, 袁琨, 郭蓓, 等. 鼻咽纤维血管瘤不同手术径路及疗效分析[J]. 第三军医大学学报, 2020,42(21):2148-2153. DOI： 10.16016/j.1000-5404.202006207.

Xiang GU, Kun YUAN, Bei GUO, et al. Different surgical approaches for juvenile nasopharyngeal angiofibroma and analysis on their efficacy[J]. Journal of Third Military Medical University, 2020, 42(21): 2148-2153. DOI： 10.16016/j.1000-5404.202006207.

摘要

目的

探讨Ⅰ期和Ⅱ期鼻咽纤维血管瘤(juvenile nasopharyngeal angiofibroma

JNA)手术方式，并探讨鼻内窥镜手术的作用和局限性。

方法

回顾性分析陆军军医大学第一附属医院2002-2018年收治的20例JNA患者传统手术和鼻内镜手术资料，传统手术方式组9例(5例面中部掀翻进路途径，4例经硬腭进路)，采用鼻内镜下肿瘤切除组11例。分析患者手术方式的选择、术中出血量、手术时间、术后住院时间、并发症的发生、复发和随访情况。

结果

所有患者病理学确诊为鼻咽血管纤维瘤，均为青少年男性，平均年龄14.6岁。与传统手术相比，经鼻内镜手术术中出血量少(509 mL

1 072 mL)，手术时间短(135 min

283 min)，术后住院时间短(5.5 d

10.8 d)，复发例数少(0

2例)。

结论

经鼻内镜入路是处理JNAs的有效手术方式，具有创伤较小、出血量少、复发率低、住院天数少等优点。栓塞后的内镜手术是治疗中小型JNA的理想方法，对于较高分期JNA患者，可考虑鼻内镜联合鼻外径路入路。

Abstract

Objective

To investigate how to choose surgical approaches for juvenile nasopharyngeal angiofibroma (JNA) at stages Ⅰ and Ⅱ

and explore the function and limitation of endoscopic surgery.

Methods

Clinical data of 20 JNA patients undergoing conventional or endoscopic surgeries in the First Affiliated Hospital of the Army Medical University between January 2002 and December 2018 were collected and retrospectively analyzed. Of them

9 patients (open surgery group) were given conventional open surgeries (including 5 cases of facial degloving approach and 4 cases of transpalatal approach)

and the other 11 patients (endoscopy group) were operated with the aid of endoscopy. The choice of surgical methods

intraoperative blood loss

length of hospitalization

incidence of complications and recurrence

and follow-up data were compared between the 2 groups.

Results

The enrolled patients were all males

at a mean age of 14.6 years

and pathologically diagnosed with NA. The endoscopy group had less intraoperative blood loss (509

1 072 mL)

shorter operation time (135

283 min)

shorter length of hospital stay (5.5

10.8 d) and lower recurrence rate (0/11

2/9) when compared to the open surgery group.

Conclusion

Endoscopic surgery is a safe and reliable technique for JNA

with the advantages of milder traumatic injury

less blood loss

lower recurrence

and shorter hospital stay. Endoscopic surgery after embolization is an ideal method for the treatment of small and medium-sized JNA. For the patients with higher stages of JNA

nasal endoscopy combined with external nasal approach may be considered.

关键词

Keywords

references

SCHICK B, RIPPEL C, BRUNNER C, et al . Numerical sex chromosome aberrations in juvenile angiofibromas: genetic evidence for an androgen-dependent tumor?[J ] . Oncol Rep, 2003, 10(5): 1251-1255.

LI W P, NI Y, LU H Y, et al . Current perspectives on the origin theory of juvenile nasopharyngeal angiofibroma[J ] . Discov Med, 2019, 27(150): 245-254.

ALIMLI A G, UCAR M, OZTUNALI C, et al . Juvenile nasopharyngeal angiofibroma: magnetic resonance imaging findings[J ] . J Belg Soc Radiol, 2016, 100(1): 63. DOI:10.5334/jbr-btr.1090.

SHENOUDA K, YUHAN B T, MIR A, et al . Endoscopic resection of pediatric skull base tumors: an evidence-based review[J ] . J Neurol Surg B Skull Base, 2019, 80(5): 527-539. DOI:10.1055/s-0038-1676305.

KOPEĆ T, BORUCKI Ł, SZYFTER W. Fully endoscopic resection of juvenile nasopharyngeal angiofibroma-own experience and clinical outcomes[J]. Int J Pediatr Otorhinolaryngol, 2014, 78(7): 1015-1018. DOI:10.1016/j.ijporl.2014.03.027.

ÁLVAREZ F L, SUÁREZ V, SUÁREZ C, et al . Multimodality approach for advanced-stage juvenile nasopharyngeal angiofibromas[J ] . Head Neck, 2013, 35(2): 209-213. DOI:10.1002/hed.22947.

MISHRA A, MISHRA S C, VERMA V, et al . In defence of transpalatal, transpalatal-circumaxillary (transpterygopalatine) and transpalatal-circumaxillary-sublabial approaches to lateral extensions of juvenile nasopharyngeal angiofibroma[J ] . J Laryngol Otol, 2016, 130(5): 462-473. DOI:10.1017/S0022215116000773.

MIDILLI R, KARCI B, AKYILDIZ S. Juvenile nasopharyngeal angiofibroma: analysis of 42 cases and important aspects of endoscopic approach[J]. Int J Pediatr Otorhinolaryngol, 2009, 73(3): 401-408. DOI:10.1016/j.ijporl.2008.11.005.

ROGERS D J, BEVANS S E, HARSHA W J. Endoscopic resection of juvenile nasopharyngeal angiofibroma[J]. Adv Otorhinolaryngol, 2012, 73: 132-136. DOI:10.1159/000334470.

REYES C, BENTLEY H, GELVES J A, et al . Recurrence rate after endoscopic vs. open approaches for juvenile nasopharyngeal angiofibroma: a meta-analysis[J ] . J Neurol Surg B Skull Base, 2019, 80(6): 577-585. DOI:10.1055/s-0038-1676562..

SAFADI A, SCHREIBER A, FLISS D M, et al . Juvenile angiofibroma: current management strategies[J ] . J Neurol Surg B Skull Base, 2018, 79(1): 21-30. DOI:10.1055/s-0037-1615810.

RADKOWSKI D, MCGILL T J, HEALY G B, et al . Angiofibroma: changes in staging and treatment[J ] . Arch Otolaryngol-Head Neck Surg, 1996, 122(2):122-129. DOI:10.1001/archotol.1996.01890140012004.

JONES J W, USMAN S, NEW J, et al . Differential gene expression and pathway analysis in juvenile nasopharyngeal angiofibroma using RNA sequencing[J ] . Otolaryngol Head Neck Surg, 2018, 159(3): 572-575. DOI:10.1177/0194599818769879.

MISHRA A, JAISWAL R, AMITA P, et al . Molecular interactions in juvenile nasopharyngeal angiofibroma: preliminary signature and relevant review[J ] . Eur Arch Otorhinolaryngol, 2019, 276(1): 93-100. DOI:10.1007/s00405-018-5178-y.

EL SHARKAWY A A, ELMORSY S M. Transnasal endoscopic management of recurrent juvenile nasopharyngeal angiofibroma[J]. Int J Pediatr Otorhinolaryngol, 2011, 75(5): 620-623. DOI:10.1016/j.ijporl.2011.01.033.

付依雯, 蒋卫红, 张俊毅, 等.儿童颅底肿瘤经鼻内镜外科手术治疗分析[J].中国耳鼻咽喉颅底外科杂志, 2020, 26(2): 121-125. DOI:10.11798/j.issn.1007-1520.202002003.

FU Y W, JIANG W H, ZHANG J Y, et al . Clinical analysis on endonasal endoscopic surgery of pediatric skull base tumors[J ] . China J Otorhinolaryngol-Skull Base Surg, 2020, 26(2): 121-125. DOI:10.11 798/j.issn.1007-1520.202002003.

GUPTA R, AGARWAL S P. Juvenile nasopharyngeal angiofibroma: combined approach for excision, transpalatal and endoscopic; A new perspective[J]. Indian J Otolaryngol Head Neck Surg, 2018, 70(1): 125-129. DOI:10.1007/s12070-016-1027-8.

HACKMAN T, SNYDERMAN C H, CARRAU R, et al . Juvenile nasopharyngeal angiofibroma: The expanded endonasal approach[J ] . Am J Rhinol Allergy, 2009, 23(1): 95-99. DOI:10.2500/ajra.2009.23.3271.

SANTAOLALLA F, ARALUCE I, ZABALA A, et al . Efficacy of selective percutaneous embolization for the treatment of intractable posterior epistaxis and juvenile nasopharyngeal angiofibroma (JNA)[J ] . Acta Otolaryngol, 2009, 129(12): 1456-1462. DOI:10.3109/00016480902725221.

赵青, 周涵, 殷敏, 等.鼻咽纤维血管瘤术前超选择性血管栓塞的应用价值[J].山东大学耳鼻喉眼学报, 2019, 33(3): 100-105. DOI:10.6040/j.issn.1673-3770.1.2019.013.

ZHAO Q, ZHOU H, YIN M, et al . Value of preoperative hyperselective vascular embolization in juvenile nasopharyngeal angiofibroma treatment[J ] . J Otolaryngol Ophthalmol Shandong Univ, 2019, 33(3): 100-105. DOI:10.6040/j.issn.1673-3770.1.2019.013.

LIU Z F, HUA W, ZHANG H K, et al . The risk factors for residual juvenile nasopharyngeal angiofibroma and the usual residual sites[J ] . Am J Otolaryngol, 2019, 40(3): 343-346. DOI:10.1016/j.amjoto.2018.11.010.

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