Boles R, Dedo H
Laryngoscope. 1976 Mar;86(3):364-72. doi: 10.1288/00005537-197603000-00006.
Nasopharyngeal angiofibromas have traditionally been difficult tumors to manage. Their extreme vascularity has led to excessive bleeding during surgical removal, which often obscured the surgical field and contributed to high recurrence rates because of incomplete removal. High recurrence rates have also been due to failure to recognize the full size and extent of these tumors preoperatively by routine physical examination and X-ray techniques. A combined experience of the authors with over 45 cases from the University of Michigan and the University of California, San Francisco, is presented to review the problems in management of these tumors and to present techniques of diagnosis and management which have been used to overcome some of these problems. The most important advances in diagnosis have been the radiographic techniques of laminagraphy and carotid angiography. Previously unrecognized tumor extensions into the areas surrounding the nasopharynx have been quite clearly demonstrated by these techniques. Improved surgical treatment of these tumors by wider surgical exposure and removal, utilizing multiple approaches when necessary, and by better control of bleeding by ligation and embolization of the main arterial supply, has led to fewer recurrences.
传统上，鼻咽血管纤维瘤是难以处理的肿瘤。其血管极其丰富，导致手术切除过程中出血过多，常常使手术视野模糊不清，且由于切除不完全而导致高复发率。高复发率还归因于通过常规体格检查和X线技术无法在术前充分认识这些肿瘤的大小和范围。本文介绍了作者在密歇根大学和加利福尼亚大学旧金山分校处理45例以上此类病例的综合经验，以回顾这些肿瘤处理过程中存在的问题，并介绍已用于克服其中一些问题的诊断和处理技术。诊断方面最重要的进展是体层摄影术和颈动脉血管造影等影像学技术。通过这些技术可以非常清晰地显示以前未被认识到的肿瘤向鼻咽周围区域的延伸。通过更广泛的手术暴露和切除、必要时采用多种入路以及通过结扎和栓塞主要动脉供应更好地控制出血等方法，改进了这些肿瘤的手术治疗，从而减少了复发。
