Coblation-assisted endoscopic excision of juvenile nasopharyngeal angiofibroma and outcomes
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摘要: 目的 总结AndrewⅠ~Ⅲ期鼻咽纤维血管瘤的手术方法和疗效。方法 收集2016年1月-2021年12月手术的鼻咽纤维血管瘤患者12例，Ⅰ期1例，Ⅱ期3例，Ⅲ期8例。采用单独经鼻内镜，或联合经口或柯陆氏入路鼻咽纤维血管瘤切除术。结果 手术未出现严重并发症。术中中位数出血量为200 mL，1例输血。中位数手术时间为110 min。中位数随访时间3年。11例完整切除，术后无复发，1例残留，行二次手术，未再复发残留。结论 通过建立标准化的手术步骤，借助内镜和低温等离子技术，AndrewⅠ~Ⅲ期的鼻咽纤维血管瘤基本可达到快速、安全、完整切除。Abstract: Objective To summarize the procedures and efficacy of surgical treatment for Andrew stage Ⅰ-Ⅲ juvenile nasopharyngeal angiofibroma(JNA).Methods A total of 12 patients with JNA who underwent surgery from 2016 to 2021 were enrolled, including 1 case in stage Ⅰ, 3 cases in stage Ⅱ, and 8 cases in stage Ⅲ. JNA was resected by transnasal endoscopic approach alone, or combined with transoral approach or Caldwell-Luc approach was performed.Results Eleven cases underwent complete resection without recurrence and 1 case had residual tumor. There were no serious complications. The median intraoperative blood loss was 200 mL, and 1 patient received blood transfusion. The median operative time was 110 minutes.Conclusion JNA in Andrew stage Ⅰ-Ⅲ can be quickly and completely resected by standardized surgical procedures using endoscopy and coblation technology.
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Key words:
- juvenile nasopharyngeal angiofibroma /
- nasal endoscope /
- surgery /
- coblation /
- outcome
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表 1 患者的一般情况、术前影像学检查、手术情况和随访
序号 年龄/岁 分期 CT/MRI最大径/cm CT/MRI示侵犯部位 估计出血量/mL 手术时间/min 住院日/d 随访时间/年 1 20 Ⅲa 6.6 NC/NP/SS/PPF/ITF 750 100 11 6.0 2 12 Ⅱ 3.6 NC/NP/SS/PPF 80 45 14 5.8 3 24 Ⅲa 4.2 NC/NP/PPF/MS/SS/ITF 450 135 12 5.5 4 14 Ⅲa 6.9 NP/NC/ES/SS/PPF/ITF 100 90 13 4.8 5 15 Ⅱ 5.6 NC/NP/SS/ES/PPF 100 60 13 4.5 6 16 Ⅲa 4.4 NC/NP/ SS/PPF/ITF 600 150 18 3.8 7 13 Ⅱ 4.5 NC/NP/PPF 200 180 18 2.5 8 11 Ⅲa 4.7 NC/NP/SS/PPF/OA 500 210 12 2.2 9 18 Ⅲa 6.6 NC/NP/SS/PPF/ITF 250 60 8 1.7 10* 14 Ⅲb 6.5 NP/MS/PPF/IC 800 230 12 1.2 11 19 Ⅰ 3.8 NC/NP 20 35 20 1.0 12 13 Ⅲa 4.2 NC/NP/MS/SS/PPF/ITF 350 120 10 0.5 *为输血和肿瘤残留二次手术患者；NC：鼻腔；NP：鼻咽部；SS：蝶窦；PPF：翼腭窝；ITF：颞下窝；MS：上颌窦；ES：筛窦；OA：眶尖；IC：颅内。 
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