鼻腔鼻窦青少年型骨化纤维瘤六例临床分析

doi:10.6040/j.issn.1673-3770.0.2018.327

摘要/Abstract

摘要： 目的分析鼻腔鼻窦青少年骨化纤维瘤的临床特点,并探讨治疗方法。方法选取2015年5月至2017年12月治疗的6例鼻腔鼻窦青少年骨化纤维瘤,男4例、女2例,年龄2个月~12岁6个月,中位年龄6岁2个月。肿瘤发生于上颌窦1例,筛窦3例,蝶窦1例,额窦1例。患儿入院后均行手术治疗,1例患儿肿物累及视神经,为保留患儿视力行鼻内镜下肿物部分切除术,术后半年发现肿物累及视神经并广泛累及颅底,行第2次鼻内镜下肿物部分切除术,术后半年因肿物复发且累及范围广泛,在第3次手术时行右侧鼻侧切开联合鼻内镜下鼻-鼻窦骨化纤维瘤部分切除术。其余患儿均行鼻内镜下肿物切除术。除1例年龄为2个月的患儿未行导航CT检查外,患儿术中均采用美敦力FUSION ENT Image Guidance System电磁导航技术对肿物边缘予以定位。另有1例患儿因肿物位于蝶窦且有明确的滋养血管,鼻内镜术前1 d予以介入血管造影及栓塞术。患儿术后均定期随访,包括鼻内镜检查及鼻窦CT检查,了解患儿术区情况、症状是否缓解及有无并发症出现。结果 6例患儿病理分型为砂砾样5例,小梁状1例。患儿均未失访,平均随访时间2.2年。其中1例复发,予以肿物部分切除,术后带瘤生存。其余患儿随访期内均未发现肿物复发且无并发症出现,患儿的原发症状均得到有效缓解。结论鼻腔鼻窦青少年骨化纤维瘤具有侵袭性生长和术后易复发的临床特点,手术是惟一有效的治疗方法。影像导航下鼻内镜手术是适合儿童的术式。

关键词: 鼻腔鼻窦, 青少年型骨化纤维瘤, 儿童, 外科手术, 影像导航

Abstract: Objective To analyze the clinical features of juvenile ossifying fibroma in the nasal cavity and sinuses and discuss the treatment. Methods From May 2015 to December 2017, 6 children(4 boys, 2 girls)with ossification fibroma of the nasal cavity and paranasal sinuses were selected with ages ranging from 2 months to 12 years 6 months, with a median age of 6 years and 2 months. The tumors occurred in the maxillary sinus(1 case), ethmoid sinus(3 cases), sphenoid sinus(1 case)and frontal sinus(1 case). All the children were treated via surgery. One case showed the involvement of the optic nerve in the tumor. Nasal endoscopy-mediated partial resection of the tumor was performed to preserve the childs eyesight. Six months after the operation, the optic nerve was found to be involved in the optic nerve and the skull base was extensively involved. The second partial resection of the tumor was performed under nasal endoscope after recurrence of the tumor involving a wider area, 6 months after the operation. During the third operation, the right nasal incision combined with nasal endoscope-mediated partial resection of the ossification fibroma of nasal sinuses was performed. All other children underwent endoscopic resection of tumors, except for one, whose age was 2 months and was not examined via computed tomography(CT). Metronic FUSION ENT Image Guidance System-based electromagnetic navigation technique was used to locate the tumor margin. Another case was treated with interventional angiography and embolization 1 day before nasal endoscopy because the tumor was located in the sphenoid sinus and had definite nourishing vessels. All the patients were followed up with regularly using nasal endoscopy and sinus CT. Results The pathological classification of 6 cases was as follows: sandy gravel in 5 cases and trabecular shape in 1 case. The average follow-up time was 2.2 years. There was one incidence of recurrence for which partial resection of the tumor was performed, and the patient survived with the tumor after the operation. No recurrence or complications were found in the other children during the follow-up period, and the primary symptoms were effectively alleviated. Conclusion Osteofibroma of the nasal cavity and paranasal sinuses has the characteristics of invasive growth and easy recurrence after operation, and surgery is the only effective treatment. Endoscopic sinus surgery with image navigation has been deemed suitable for children.

Key words: Nasal sinuses, Juvenile ossifying fibroma, Pediatrics, Surgical procedures, operative, Image navigation system

中图分类号:

R739.62

韩阳,杨小健,唐力行,王蓬鹏,张杰,葛文彤. 鼻腔鼻窦青少年型骨化纤维瘤六例临床分析[J]. 山东大学耳鼻喉眼学报, 2018, 32(6): 79-83.

HAN Yang, YANG Xiaojian, TANG Lixing, WANG Pengpeng, ZHANG Jie, GE Wentong. Clinical features and treatment of juvenile ossifying fibroma of the nasal cavity and sinuses[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(6): 79-83.

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