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摘要: 目的 分析鼻腔呼吸上皮腺瘤样错构瘤(respiratory epithelial adenomatoid hamartoma，REAH)病理及临床特点，总结诊断要点，提高该病诊治经验。方法 回顾性分析16例REAH的临床资料，总结该病的临床表现、病理学特点、影像学特征、手术治疗方式及预后。结果 16例鼻腔REAH患者，同时伴有鼻窦炎10例(62.50%)，伴有内翻性乳头状瘤1例(6.25%)，伴有血管瘤1例(6.25%)；5例(31.25%)患者有鼻腔鼻窦手术史，其中1例有3次鼻腔鼻窦手术史，1例有2次鼻腔鼻窦手术史，3例有1次鼻腔鼻窦手术史；发生于双侧嗅裂10例(62.50%)，单侧嗅裂2例(12.50%)，单侧中鼻甲3例(18.75%)，鼻咽部1例(6.25%)。16例患者均经病理诊断为REAH，其中病变位于双侧嗅裂患者的术前鼻窦CT上均可观察到嗅裂对称性增宽及中鼻甲外移，双侧嗅裂宽度平均为(9.90±2.70) mm，宽窄嗅裂比值为1.21±0.19，两侧鼻窦Lund-Mackay评分差异无统计学意义。患者手术均在全身麻醉鼻内镜下完成，随访1~66个月，均无复发。结论 结合临床表现及内镜检查和影像学特征有助于REAH的术前诊断，通过内镜下的完整切除可以达到良好的治疗效果。Abstract: Objectives To analyze the pathological and clinical features of nasal respiratory epithelial adenomatoid hamartoma(REAH), and summarize the diagnostic points, to improve the experience of diagnosis and treatment.Methods The clinical data of 16 patients with REAH were analyzed retrospectively. The clinical manifestations, pathological features, imaging features, surgical treatment and prognosis were summarized.Results 16 cases of REAH were studied, 10 cases(62.50%) were associated with sinusitis, 1 case(6.25%) was associated with inverted papilloma, 1 case(6.25%) was associated with hemangioma. 5 cases(31.25%) had a history of nasal sinus surgery, including 1 case with 3 times of nasal sinus surgery, 1 case with 2 times of nasal sinus surgery, 3 cases with 1 time of nasal sinus surgery; 10 cases(62.50%) occurred in the bilateral olfactory cleft, 2 cases(12.50%) in the unilateral olfactory cleft, 3 cases(18.75%) in the unilateral middle turbinate, 1 case(6.25%) in the nasopharynx. All 16 patients were pathologically diagnosed as REAH. In the patients with lesions located in bilateral olfactory fissures, symmetrical widening of olfactory fissures and lateral displacement of middle turbinate were observed on preoperative sinus CT. The average width of bilateral olfactory fissures was (9.9±2.70) mm. The ratio of wide to narrow olfactory cleft was 1.21 ± 0.19. There was no significant difference in Lund-Mackay score between the two sides(P>0.05). All patients underwent surgery under general anesthesia and nasal endoscopy. The follow-up period ranged from 1 to 66 months, and no recurrence occurred.Conclusion Preoperative diagnosis of REAH is facilitated by the combination of clinical manifestations and endoscopic and imaging features. Endoscopic complete resection can achieve a good therapeutic effect.
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Key words:
- nasal cavity /
- hamartoma /
- diagnosis /
- endoscopic surgery
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