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"

1 魏玉梅, 蔡晓岚, 张国丽, 等. 鼻咽纤维血管瘤研究进展[J]. 山东大学耳鼻喉眼学报, 2006, 20(3): 193-196. doi:10.3969/j.issn.1673-3770.2006.03.001.
doi: 10.3969/j.issn.1673-3770.2006.03.001
2 PeiR, YangM, WangJ,et al.Efficacy and safety of preoperative internal maxillary arterial embolization with gelfoam for nasopharyngeal angiofibroma[J]. Eur Arch Otorhinolaryngol,2019, Jan 3.doi:10.1007/s00405-018-05276-6
doi: 10.1007/s00405-018-05276-6
3 刘婷婷, 王学海, 蔡晓岚, 等. 鼻内镜下口-鼻联合径路切除鼻底累及硬腭巨大肿瘤两例[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 108-111. doi:10.6040/j.issn.1673-3770.0.2017.333.
doi: 10.6040/j.issn.1673-3770.0.2017.333
LIUTingting, WANGXuehai, CAIXiaolan, et al. Excision of giant tumor in nasal floor involving palatine via oral-nasal combined approach under a nasal endoscope assisted: a report of 2 cases[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(3): 108-111. doi:10.6040/j.issn.1673-3770.0.2017.333.
doi: 10.6040/j.issn.1673-3770.0.2017.333
4 秦贺, 胡斌, 叶京英, 等. 鼻和咽部原发性非霍奇金淋巴瘤17例临床分析[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 51-53. doi:10.6040/j.issn.1673-3770.0.2017.199.
doi: 10.6040/j.issn.1673-3770.0.2017.199
QINHe, HUBin, YEJingying, et al. Clinical analysis of 17 patients with primary non-Hodgkin's lymphoma in the nose and the pharynx[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2017, 31(4): 51-53. doi:10.6040/j.issn.1673-3770.0.2017.199.
doi: 10.6040/j.issn.1673-3770.0.2017.199
5 LópezF, TriantafyllouA, SnydermanCH, et al. Nasal juvenile angiofibroma: Current perspectives with emphasis on management[J]. Head Neck, 2017, 39(5): 1033-1045. doi:10.1002/hed.24696.
doi: 10.1002/hed.24696
6 JanakiramN, SharmaSB, PanickerVB,etal. A drastic aftermath of embolisation in juvenile nasopharyngeal angiofibroma[J]. Indian J Otolaryngol Head Neck Surg ,2016,68:540-543.doi:10.1007/s12070-016-1014-0
doi: 10.1007/s12070-016-1014-0
7 吴贤敏, 李志春, 易自翔, 等. 鼻咽血管纤维瘤的研究现状[J]. 山东大学耳鼻喉眼学报, 2007, 21(1): 81-85. doi:10.3969/j.issn.1673-3770.2007.01.027.
doi: 10.3969/j.issn.1673-3770.2007.01.027
8 Oré AcevedoJF, La Torre CaballeroLM, Urteaga QuirogaRJ. Juvenile nasopharyngeal angiofibroma surgical treatment in paediatric patients[J]. Acta Otorrinolaringol Esp, 2018: S0001-S6519(18)30125-0. doi:10.1016/j.otorri.2018.06.003.
doi: 10.1016/j.otorri.2018.06.003
9 蔡葶, 周兵, 黄谦, 等. 鼻内镜下鼻咽纤维血管瘤切除术预后因素分析[J]. 临床耳鼻咽喉头颈外科杂志, 2010, 24(22): 1035-1039. doi:10.3969/j.issn.1001-1781.2010.22.009.
doi: 10.3969/j.issn.1001-1781.2010.22.009
CAITing, ZHOUBing, HUANGQian, et al. Analysis of prognostic factors in endoscopic surgery for juvenile nasopharyngeal angiofibroma[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2010, 24(22): 1035-1039. doi:10.3969/j.issn.1001-1781.2010.22.009.
doi: 10.3969/j.issn.1001-1781.2010.22.009
10 孙景元. 内窥镜下超声刀切除鼻咽纤维血管瘤的临床效果分析[J]. 临床医药文献电子杂志, 2017, 4(49): 9545. doi:10.3877/j.issn.2095-8242.2017.49.027.
doi: 10.3877/j.issn.2095-8242.2017.49.027
11 YiZX, FangZM, LinGB, et al. Nasopharyngeal angiofibroma: a concise classification system and appropriate treatment options[J]. Am J Otolaryngol, 2013, 34(2): 133-141. doi:10.1016/j.amjoto.2012.10.004.
doi: 10.1016/j.amjoto.2012.10.004
12 MehanR, RupaV, LukkaVK, et al. Association between vascular supply, stage and tumour size of juvenile nasopharyngeal angiofibroma[J]. Eur Arch Otorhinolaryngol, 2016, 273(12): 4295-4303. doi:10.1007/s00405-016-4136-9.
doi: 10.1007/s00405-016-4136-9
13 TrivediM., DesaiRJ, Potdar NA, et al. Vision loss due to central retinal artery occlusion following embolization in a case of a giant juvenile nasopharyngeal angiofibroma[J]. Journal of Craniofacial Surgery, 2015, 26(5): 451-453.doi:10.1097/scs.0000000000-001936
doi: 10.1097/scs.0000000000-001936
14 GarofaloP, PiaF, PolicarpoM, et al. Juvenile nasopharyngeal angiofibroma: comparison between endoscopic and open operative approaches[J]. J Craniofac Surg, 2015, 26(3): 918-821. doi:10.1097/SCS.00000000000-01693.
doi: 10.1097/SCS.00000000000-01693
15 TanG, MaZ, LongW, et al. Efficacy of preoperative transcatheter arterial embolization for nasopharyngeal angiofibroma: a comparative study[J]. Cardiovasc Interv Radiol,2017, 40（6）:836-844. doi： 10.1007/s00270-017-1587-3.
doi: 10.1007/s00270-017-1587-3
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