鼻咽纤维血管瘤术前超选择性血管栓塞的应用价值

doi:10.6040/j.issn.1673-3770.1.2019.013

摘要/Abstract

摘要： 目的

分析鼻咽纤维血管瘤的临床特征、诊断方法、手术方式、预后以及术前行超选择性血管栓塞的临床应用价值。

方法

回顾性分析南京医科大学第一附属医院2007年1月~2018年7月收治的31例经病理证实为鼻咽部纤维血管瘤患者的临床资料。患者均依据术前影像学检查结果进行临床分期并制定手术方案（根据Radkowski分期，Ⅰa期患者11例、Ⅰb期7例、Ⅱa期7例、Ⅱb期3例、Ⅱc期2例、Ⅲa期 1例）。其中16例行经鼻内镜手术，9例行经硬腭径路，5例行经口腔径路,1例行鼻侧切开；13例患者术前行超选择性血管介入栓塞术。

结果

术后3例患者失访，其余28例患者平均随访6个月~5年，有5例患者出现复发。术前行超选择性动脉栓塞的患者手术时间和术中出血量较未栓塞患者均显著减少，差异具有统计学意义(P<0.05)。分期较晚的Ⅱ～Ⅲ期患者术前栓塞比例、术中出血量均明显高于Ⅰ期，差异具有统计学意义(P<0.05)。

结论

鼻咽纤维血管瘤临床表现多变，术前应通过详细的影像学检查手段如CT、MRI及数字血管造影检查等来进行准确的分期，Radkowski分期系统有助于指导该疾病的诊疗。术前行超选择性血管栓塞可显著减少术中出血、缩短手术时间并降低复发率。

关键词: 鼻咽纤维血管瘤, 肿瘤分期, 栓塞,治疗性, 外科手术, 预后

Abstract: Objective

To summarize and analyze the clinical features, diagnostic methods, surgical approach, prognosis, and clinical value of preoperative hyperselective vascular embolization for juvenile nasopharyngeal angiofibroma (JNA).

Methods

Retrospective analysis of 31 patients with pathologically confirmed nasopharyngeal fibroangioma in the First Affiliated Hospital of Nanjing Medical University from January 2007 to July 2018 was performed. All patients underwent clinical staging based on preoperative imaging findings (according to Radkowski staging, 11 cases in stage Ia, seven in Ib, seven in IIa, three in IIb, two in IIc, and one in IIIa) after which surgical plans were developed. Sixteen patients underwent nasopharyngeal angiofibroma resection via a nasal endoscopy approach, nine via a nasal-hard palate approach, five via an oral approach, and one via a nasal side incision approach. Among all patients, 13 patients underwent selective vascular interventional embolization before surgery.

Results

Three patients were lost to follow-up. The remaining 28 patients were followed up for 6 months to 5 years and five patients developed recurrence of the disease. The operation time and intraoperative blood loss of patients with hyperselective arterial embolization before surgery were significantly lower than those without embolization (P<0.05). Preoperative embolization rate and intraoperative blood loss were significantly higher in patients with stage II?III JNA (P<0.05).

Conclusion

The clinical manifestations of JNA are variable. Preoperative detailed imaging methods such as computed tomography, magnetic resonance imaging, and digital angiography can help to perform accurate staging and develop a reasonable surgical plan. Preoperative Radkowski staging helps to guide the treatment of JNA. Preoperative hyperselective vascular embolization can reduce intraoperative blood loss, reduce the operation time, and reduce the recurrence rate significantly, which is worth advocating further.

Key words: Juvenile nasopharyngeal angiofibroma, Neoplasm staging, Embolization， therapeutic, Surgical procedures, operative, Prognosis

中图分类号:

R765

赵青,周涵,殷敏,冯剑,张佳程,刘雅琴,沈宇杰,林子萍,董伟达. 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.

Qing ZHAO,Han ZHOU,Min YIN,Jian FENG,Jiacheng ZHANG,Yaqin LIU,Yujie SHEN,Ziping LIN,Weida DONG. Value of preoperative hyperselective vascular embolization in juvenile nasopharyngeal angiofibroma treatment[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(3): 100-105.

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指标	术前栓塞组	对照组	P	Wilcoxon W
肿瘤最大径（cm）	3.2±1.3	3.0±1.3	0.600	275.000
术中出血量（mＬ）	432.3±157.8	763.9±282.7	0.001	124.500
住院总天数（d）	11.0±5.4	11.9±4.9	0.376	186.000
术后住院天数（d）	5.8±3.3	6.7±4.0	0.404	187.500
手术时间（min）	72.7±23.0	112.8±45.4	0.035	155.500
复发[n(%)]	1（7.7）	4（22.2）	0.368^＃	/

指标	早期（Ⅰ期）	中晚期（Ⅱ,Ⅲ期）	Wilcoxon W	P
术前栓塞[n (%)]	4/18（22.2）	9/13（69.2）	/	0.013^#
肿瘤最大径(cm)	2.2±0.7	4.3±0.8	177.500	＜0.001
手术时间(min)	100.2±49.6	95.6±31.5	202.500	0.825
术中出血量（mL）	507.2±195.7	787.7±321.8	227.500	0.015
总住院天数（d）	12.2±6.0	10.6±3.5	195.000	0.601
术后住院天数（d）	6.9±4.0	5.5±3.1	172.500	0.148
复发[n（%）]	1（4.0）	4（30.8）	/	0.134^#