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目的探讨鼻内镜下鼻咽血管纤维瘤(juvenile nasopharyngeal angiofibroma,JNA)切除的可行性及手术方法。方法回顾性分析21例经鼻内镜下切除的JNA患者的病例资料。根据Sessions等的肿瘤分期标准,将JNA患者分为A组(没有侵犯到颅内者)和B组(侵犯到颅内者)。21例患者均经鼻内镜下完成手术,其中2例采用面中部掀翻进路联合鼻内镜下的手术方式。观察记录肿瘤的分期、术中平均失血量、术后有无肿瘤残留和(或)肿瘤复发。结果A组19例患者术中平均失血量1000 ml,随访8个月至2年,无肿瘤残留或复发病例。B组2例患者术中平均失血量1500 ml,其中1例海绵窦附近有肿瘤残留,随访2年没有疾病进展的表现;另1例随访8个月,没有发现肿瘤残留和复发。结论使用鼻内镜技术治疗JNA,并配合其他一些相关技术,对局限于鼻腔、鼻咽腔、筛蝶窦、部分侵及翼腭窝及小范围侵犯颅内的JNA患者是适宜的。
Objective To investigate the feasibility and operation of nasal endoscopic nasopharyngeal angiofibroma (JNA) resection. Methods A retrospective analysis of 21 cases of endoscopic nasal endoscopic resection of JNA case data. According to Sessions and other tumor staging criteria, JNA patients were divided into A group (no violation of the intracranial) and B (violation of the intracranial). Twenty-one patients underwent endoscopic sinus surgery, two of whom underwent median facelift and endoscopic sinus surgery. Observe and record the staging of the tumor, average intraoperative blood loss, postoperative tumor residual and / or tumor recurrence. Results The average blood loss of 19 patients in group A was 1000 ml. The patients were followed up for 8 months to 2 years without any tumor residue or recurrence. Two patients in group B had an average intraoperative blood loss of 1500 ml, of which 1 had residual tumor near the cavernous sinus with no disease progression at 2 years of follow-up. The other 1 patient was followed up for 8 months and no residual tumor and recurrence were found. Conclusions The use of endoscopic sinus surgery in the treatment of JNA, together with other related techniques, is appropriate for JNA patients confined to the nasal cavity, nasopharynx cavity, sphenopalatine fossa, partial invasion of the pterygopalatine fossa and intracranial invasion of a small area.