Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2019, Vol. 33 ›› Issue (3): 100-105.doi: 10.6040/j.issn.1673-3770.1.2019.013

• Original Article • Previous Articles     Next Articles

Value of preoperative hyperselective vascular embolization in juvenile nasopharyngeal angiofibroma treatment

Qing ZHAO,Han ZHOU,Min YIN,Jian FENG,Jiacheng ZHANG,Yaqin LIU,Yujie SHEN,Ziping LIN,Weida DONG()   

  1. Department of Otorhinolaryngology, The First Affiliated Hospital, Nanjing Medical University，Nanjing 210029，Jiangsu，China
  • Received:2019-02-26 Revised:2019-04-26 Online:2019-05-20 Published:2019-08-07
  • Contact: Weida DONG E-mail:weidadong2649@126.com

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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

CLC Number: 

  • R765

Table 1

Comparison of operation time, intraoperative blood loss, postoperative hospital stay and total hospitalization days between the preoperative embolization group and the control group（xˉ±s）"

指标术前栓塞组对照组PWilcoxon W
肿瘤最大径（cm）3.2±1.33.0±1.30.600275.000
术中出血量（mＬ）432.3±157.8763.9±282.70.001124.500
住院总天数（d）11.0±5.411.9±4.90.376186.000
术后住院天数（d）5.8±3.36.7±4.00.404187.500
手术时间（min）72.7±23.0112.8±45.40.035155.500
复发[n(%)]1（7.7）4（22.2）0.368＃/

Table 2

The clinical data of patients grouped according to Radkowski preoperative staging system (early group and middle-late group)（xˉ±s）"

指标早期（Ⅰ期）中晚期（Ⅱ,Ⅲ期）Wilcoxon WP
术前栓塞[n (%)]4/18（22.2）9/13（69.2）/0.013#
肿瘤最大径(cm)2.2±0.74.3±0.8177.500＜0.001
手术时间(min)100.2±49.695.6±31.5202.5000.825
术中出血量（mL）507.2±195.7787.7±321.8227.5000.015
总住院天数（d）12.2±6.010.6±3.5195.0000.601
术后住院天数（d）6.9±4.05.5±3.1172.5000.148
复发[n（%）]1（4.0）4（30.8）/0.134#

Fig.1

Imaging and endoscopic data of patient No. 1"

Fig. 2

Imaging data of patient No. 2"

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