Hosseini Seyed Mousa Sadr, Borghei Peyman, Borghei Seyed Hebatodin, Ashtiani Mohammad Taghi Khorsandi, Shirkhoda Ali
Department of ENT of Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Eur Arch Otorhinolaryngol. 2005 Oct;262(10):807-12. doi: 10.1007/s00405-004-0910-1. Epub 2005 Mar 1.
Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor of the nasopharynx, and for its treatment, many surgical approaches have been recommended. However, selecting the appropriate one for the tumor in an advanced stage is still controversial. In this study, we evaluate the rate of recurrence of JNA and its relationship to the preoperative stage as well as various surgical approaches. Thirty-seven patients with pathologically proven JNA were retrospectively analyzed. For each patient, data were obtained regarding the primary extension, various surgical approaches and rate of recurrence. Seven patients were in stage III with intracranial extensions. Two of these patients had symptomatic recurrence that needed surgery. Three of them were disease free, and in two cases residues were demonstrated that were asymptomatic and were chosen only to be observed. Among different surgical approaches used, the transpalatal resulted in 1 recurrence out of 14 patients treated with this approach when the lesion was limited to the nasal cavity, nasopharynx and paranasal sinuses (stage I). No recurrence was observed with the use of this approach with lesions with minimal extension to the pterygopalatine fossa (stage IIA). But among three patients with intracranial extension who were treated with this approach, two resulted in symptomatic recurrence; however, using the Lefort I surgical technique, no evidence of recurrence was observed in the two patients in stage III who were treated with this approach. Involvement of the orbit, middle cranial fossa and base of the pterygoid by the primary JNA results in a higher incident of recurrent tumor. Among different surgical techniques, the lowest recurrence rate is seen either in the transpalatal approach when the tumor is limited to the nasopharynx with extension to the nasal cavity or paranasal sinuses or with the Lefort I approach when skull base invasion is present.
青少年鼻咽血管纤维瘤（JNA）是一种鼻咽部的良性肿瘤，对于其治疗，已推荐了多种手术方法。然而，为晚期肿瘤选择合适的手术方法仍存在争议。在本研究中，我们评估了JNA的复发率及其与术前分期以及各种手术方法的关系。对37例经病理证实的JNA患者进行了回顾性分析。对于每位患者，获取了有关原发灶扩展、各种手术方法和复发率的数据。7例患者处于Ⅲ期，有颅内扩展。其中2例患者出现有症状的复发，需要再次手术。3例患者无疾病复发，2例患者有残留病灶，无症状，仅选择观察。在使用的不同手术方法中，当病变局限于鼻腔、鼻咽和鼻窦（Ⅰ期）时，经腭入路治疗的14例患者中有1例复发。对于病变仅轻微扩展至翼腭窝（ⅡA期）的患者，使用该入路未观察到复发。但在3例采用该入路治疗的颅内扩展患者中，2例出现有症状的复发；然而，采用勒福Ⅰ型手术技术，在2例采用该入路治疗的Ⅲ期患者中未观察到复发迹象。原发JNA累及眼眶、中颅窝和翼突基部会导致肿瘤复发的发生率更高。在不同的手术技术中，当肿瘤局限于鼻咽并扩展至鼻腔或鼻窦时，经腭入路的复发率最低；当存在颅底侵犯时，勒福Ⅰ型入路的复发率最低。
