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.

参考文献

[1] Alsharif MJ, Sun ZJ, Chen XM, et al. Benign fibro-osseous lesions of the jaws: a study of 127 Chinese patients and review of the literature[J]. Int J Surg Pathol, 2009,17(2):122-134.
[2] 刘红刚,高岩.头颈部肿瘤病理学和遗传学[M].北京:人民卫生出版社,2006:374-380.
[3] Linhares P, Pires E, Carvalho B, et al. Juvenile psammomatoid ossifying fibroma of the orbit and paranasal sinuses. a case report[J]. Acta Neurochir, 2011, 153(10):1983-1988.
[4] Mintz S, Velez I. Central ossifying fibroma: an analysis of 20 case and review of the literature[J]. Quintessence Int, 2007, 38(3):221-227.
[5] Noudel R, Chauvet E, Cahn V, et al. Transcranial resection of a large sinonasal juvenile psammomatoid ossifying fibroma[J]. Childs Nerv Syst, 2009, 25:1115-1120.
[6] Carlos CQ, Anwar SM, Juan RB, et al. Juvenile psammomatoid ossifying fibroma of the posterior fossa: a case report and review[J]. Springer Plus, 2016, 5:1089.
[7] Barnes L, Eveson JW, Reichart P. World Health Organization Classification of Tumours[M]. Pathology and Genetics of Head and Neck Tumours, Lyon: IARC Press, 2005: 283-328.
[8] Khoury NJ, Naffaa LN, Shabb NS, et al. Juvenile ossifying fibroma: CT and MR findings[J]. Eur Radiol, 2002, 12:109-113.
[9] 宋善芳,陈雪松,黄鹏,等.儿童鼻腔鼻窦骨化纤维瘤[J].中国耳鼻咽喉头颈外科,2009,16(6):320-322.
[10] Harris MS, Vernon DJ, Agostino MA. An infant with right eye proptosis[J]. JAMA Otolaryngol Head Neck Surg, 2014, 140(5):471-472.
[11] Phattarataratip E, Pholjaroen C, Tiranon PA. Clinicopathologic analysis of 207 cases of benign fibro-osseous lesions of the jaws[J]. Int J Surg Pathol, 2014, 22(4):326-333.
[12] Owosho AA, Hughes MA, Prasad JL, et al. Psammomatoid and trabecular juvenile ossifying fibroma: two distinct radiologic entities[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2014, 118(6):732-738.
[13] 王永哲,陈光利,王振常,等.鼻腔及鼻窦骨化性纤维瘤的MRI诊断[J].临床放射学杂志,2007,26(11):1088-1091.
[14] Reddy AV, Reddy KR, Prakash AR, et al. Juvenile ossifying fibroma with aneurysamal bone cyst: a case report[J]. J Clin Diagn Res, 2014, 8(10):ZD01-ZD02.
[15] Abuzinada S, Alyamani A. Management of juvenile ossifying fibroma in the maxilla and mandible[J]. J Maxillofac Oral Surg, 2010, 9(1):91-95.
[16] Cicciu M, Herford AS, Juodzbalys G, et al. Juvenile ossifying fibroma of the maxilla: a rare aggressive case in a young patient[J]. J Cancer Res Ther, 2013, 9(2):324-327.
[17] 韩婧,田臻,张春叶,等.颌骨青少年骨化纤维瘤—15例临床回顾分析[J].中国肿瘤临床,2015,42(16):834-840.
[18] Noudel R, Chauvet E, Cahn V, et al. Transcranial resection of a large sinonasal juvenile psammomatoid ossifying fibroma[J]. Childs Nerv Syst, 2009, 25(9):1115-1120.
[19] 王明婕,周兵,崔顺九,等.影像导航引导鼻内镜下切除鼻颅底骨化纤维瘤[J].中国耳鼻咽喉头颈外科,2011,18(3):141-144.
[20] Wang M, Zhou B, Cui S, et al. Juvenile psammomatoid ossifying fibroma in paranasal sinus and skull base[J]. Acta Otolaryngol, 2017, 137(7):743-749.
[21] Rosen CA, Cohe JL, Coal FS. Psammotoid ossifying fibroma of the ethmoid sinus[J]. Arch Otolaryngol Head Neck Surg, 1992, 118:1128-1131.
[22] Nakagawa K, Takasato Y, Ito Y, et al. Ossifying fibroma involving the paranasal sinuses, orbit, and anterior cranial fossa[J]. Neurosurgery, 1995, 36(6):1192-1195.
[23] 崔顺九,周兵,韩德民,等.鼻窦骨化纤维瘤手术探讨[J].中华耳鼻咽喉科杂志,2003,38(6):468-470.
[24] 周兵,韩德民,葛文彤,等.影像导航引导鼻内镜下前颅底骨化纤维瘤切除术[J].中国耳鼻咽喉头颈外科,2005,12(11):706-708.

相关文章 15

[1]	朱希倩,王佳,孙祖贤,冯建秀,张梦佳,赵颖,王宏,姜敏敏. 上海市杨浦区2022—2024年6~9岁学龄儿童屈光状态分析[J]. 山东大学耳鼻喉眼学报, 2026, 40(3): 102-109.
[2]	宋艳玲,司元元,崔彦. 微量玻璃体切除治疗激光笔致儿童全层黄斑裂孔1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 144-147.
[3]	陈涛,姜洋,李莹. SMILE矫正PRK术后屈光回退1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(6): 148-153.
[4]	刘南仙,杨泽垠,韩琳,张爱英,赵宇亮,薛静,孙怡君,邵永良. 视频脑电图在儿童复发性眩晕诊断中的意义[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 20-25.
[5]	黄焕,华红利,邓玉琴,江承洋,王雨薇,杨星海. 儿童过敏性鼻炎、扁桃体腺样体肥大和鼻窦炎之间相关性及其对临床指导价值[J]. 山东大学耳鼻喉眼学报, 2025, 39(5): 34-41.
[6]	王华,张丰珍,龙婷,赵靖,李宏彬,王生才,王桂香. 后颅窝肿瘤术后儿童气管切开原因及预后转归分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 168-173.
[7]	乐冰艳,邹剑,雷蕾,文巧,钱应雪. 儿童扁桃体微生物群与免疫调节及疾病关联[J]. 山东大学耳鼻喉眼学报, 2025, 39(4): 193-200.
[8]	黄爱萍,王娟,王丽,耿江桥,王亚芳,温鑫. 儿童原发扁桃体Burkitt淋巴瘤累及上颌骨和肺1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(3): 148-152.
[9]	毕恒,谢佳,龚辉成. p-mTOR、p-S6K在鼻腔鼻窦内翻性乳头状瘤中的高表达及临床价值[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 25-34.
[10]	刘畅,杨景朴,高雨,王文佳. 长春地区儿童变应性鼻炎变应原检测结果分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 51-58.
[11]	付圣尧,陈敏,庞文会,李娜. 内镜辅助个体化手术入路治疗儿童鼻中线囊肿及瘘管[J]. 山东大学耳鼻喉眼学报, 2025, 39(2): 65-71.
[12]	陈丹萍,何子键,虞幼军,周晓娓. 儿童突发性聋10年住院病例的疗效及预后相关因素分析[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 16-22.
[13]	杨娜,柳荫,郭宝,纪尧峰,成晨,张琛,董丽娜. 高频超声在儿童鼻骨骨折闭合复位术的应用研究[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 41-45.
[14]	王登茂,温鑫,耿江桥,张光远,刘晓峰. 儿童咽鼓管毛息肉合并鼻咽部错构瘤1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2025, 39(1): 105-109.
[15]	姚婷婷,张德伦,李兰. 婴儿下咽部胃黏膜异位症引发咽喉反流症状1例并文献回顾[J]. 山东大学耳鼻喉眼学报, 2024, 38(6): 126-130.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed