【摘要】 目的探讨经鼻腔鼻内镜下及鼻内镜引导下的鼻咽纤维血管瘤手术切除技术。方法回顾性分析11例经鼻内镜下及鼻内镜引导下的鼻咽纤维血管瘤切除术的临床资料。11例中,2例行术前颈外动脉结扎,2例术中行颈外动脉暂时性阻断术,7例行超选择动脉内栓塞术;9例患者行鼻内镜下经鼻腔肿瘤切除术,2例患者联合鼻内镜下及鼻内镜引导下经Caldwell-Luc切口进路切除肿瘤。结果Ⅰ、Ⅱ期患者中,4例术前行颈外动脉结扎术或术中颈外动脉暂时性阻断术,术中出血平均为250ml;5例术前行超选择动脉内栓塞术,术中出血平均为150ml。2例Ⅲ期患者术前行超选择动脉内栓塞术,术中出血为450ml。所有病例的肿瘤均为一期安全切除,随访6个月～4年无复发。结论鼻内镜下及鼻内镜引导下经柯-陆径路可完整切除位于鼻腔及鼻窦,甚至远至翼腭窝的鼻咽纤维血管瘤,并发症少,面部不留瘢痕。如若配合术前超选择动脉内栓塞术,术中出血量则明显减小。更多还原

【Abstract】 Objective To investigate the fesible surgical techniques and the therapeutic effect of nasal endoscopic or endoscope-assisted operating therapies for resection of nasopharyngeal angiofibroma based on a retrospective study.Methods A retrospective study was carried out in this study among 11 cases with nasopharyngeal angiofibroma treated in our Hospital during recent years via nasal endoscopic and/or endoscope-assisted approaches.Among these cases,ligation of external carotid artery was per- formed preoperatively in 2 cases;transient block of external carotid artery performed during the oper- ating period in 2,super selective intra-arterial embolization carried out preoperatively in 7 cases,while the tumors were removed by trans-nasal endoscopic surgery in 9 cases and removed 2 cases by a com- bined way with endoscopic and endoscope-assisted trans-nasal Caldwell-Luc approaches.Results Among the cases with their tumors at stageⅠorⅡ,4 cases received ligation of external carotid artery preoperatively or transient block of the external carotid artery during the operating period had an aver- aged bleeding volume about 250ml during the surgery and the other 5 cases received super selective in- tra-arterial embolization preoperatively had such an averaged bleeding volume about 150ml during the operation.For the 2 cases with their tumors at stageⅢ,they had an averaged bleeding volume only about 450ml during the combined surgical procedures following the super selective intra-arterial embo- lization preoperatively.Furthermore,the tumors of these cases were all thoroughly removed at only once surgery and none was with the lesion reoccurred during the following up period last for 6 to 48months.Conclusions Via the nasal endoscopic approach and/or the endoscope-assisted Caldwell- Luc approach,nasopharyngeal angiofibroma can be removed totally at once surgery,even if it involving fossa pterygopalatina out of the nasopharynx,with very less complications occurred and no scar rema- ined in the region of face.Once such techniques are combined together with super selective intra-arteri- al embolization performed preoperatively,the total volume of bleeding will be reduced obviously during the period of operation for such cases.更多还原