Clinical characteristics and surgical treatment analysis of paranasal ossifying fibroma
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摘要: 目的 探讨鼻窦骨化纤维瘤的治疗方法并分析其临床特点。方法 18例鼻窦骨化纤维瘤患者均行手术治疗，其中6例利用电磁导航辅助鼻内镜下切除肿瘤，8例行单纯鼻内镜下肿瘤切除，2例行鼻内镜下鼻外联合径路肿瘤切除，1例行鼻内镜下下鼻道开窗入路肿瘤切除术，1例唇龈沟入路肿瘤切除。结果 骨化纤维瘤患者术中出血量较大，平均出血量550 mL。所有患者术后随访6个月~8年，15例完全切除者术后均未复发，3例部分切除者带瘤生存。结论 鼻窦骨化纤维瘤经鼻内镜手术可彻底切除病变，创伤小且疗效好。对侵犯眶纸板和前颅底的病变，采用电磁导航辅助技术可保护重要结构; 对侵犯额窦的病变可行鼻内镜联合眉弓小切口进路。骨化纤维瘤易出血，需术前充分评估并备血，血运丰富的瘤体需术前辅以介入治疗。Abstract: Objective To analyze the clinical features and discuss the treatment of ossifying fibroma in the nasal cavity and sinuses.Method The patients were performed surgical treatment after admission. 6 cases were treated by endoscopic transnasal approach with image guidance system to resect the mass, 8 cases were operated by simple endoscopic approach, tumor resection was performed via endoscopic surgery with external approach in 2 cases, and endoscopic surgery combined with modified Caldwell-Luc procedure in 1 case. 1 patient was operated through labiolingual groove approach.Result The intraoperative blood loss of ossified fibroma patients was large, with an average blood loss of 550ml. All the patients were followed up for 6 months to 8 years, 15 patients with complete resection had no recurrence after surgery, and 3 patients with partial resection survived with tumor.Conclusion Ossifying fibroma in the nasal cavity and sinuses can be completely resected by nasal endoscopic surgery with less trauma and good effect. Transnasal endoscopic surgery assisted by image navigation system can protect important structures in lesions involving orbital cardboard and anterior skull base. Nasal endoscopic surgery combined with small eyebrow incision approach is feasible for ossifying fibroma invading frontal sinus. Ossifying fibroma, which requires adequate preoperative evaluation and blood preparation is prone to bleeding, and lesions with rich blood supply need preoperative interventional therapy.
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