Zhou Bing, Cai Ting, Huang Qian, Liang Xi-hong, Ni Xin, Wei Yong-xiang, Cui Shun-jiu, Zhang Luo, Wang Tong, Liu Hua-chao, Liu Ming, Han De-min
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Key Laboratory of Otorhinolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing 100730, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2010 Mar;45(3):180-5.
To present the changes of surgical approaches for the resection of juvenile nasopharyngeal angiofibromas (JNA) and the follow-up results.
The clinical records of 59 patients with JNA treated under endoscope between 2002 and 2009 were reviewed retrospectively. The patients were divided into two groups: Group A (Radkowski I a-II b) and Group B (Radkowsik II c-III b). The tumor stages, feeding vessels, operating time, complications and recurrence were observed and recorded.
There were 7 patients with stage I a, 3 patients with stage I b, 5 patients with stage II a, 6 patients with stage II b, 4 patients with stage II c, 23 patients with stage III a, 11 patients with stage III b. The average age at diagnosis in Group A (21 cases) was 23.9 years old. The average operating time was (106.0 +/- 43.7) min. The follow-up ranged from 3 months to 74 months (median 36 months) except for 3 missing cases. The average age at diagnosis in Group B (38 cases) was 16.2 years old and the average operating time was (152.9 +/- 58.0) min. The follow-up ranged from 3 months to 87 months (median 25 months) except for 5 missing cases. During follow-up, 6 patients in group B recurred. Infarction of thalamencephalon happened in 1 patient in group B who recovered totally afterwards. The difference in operating time between two groups was statistically significant (t = -3.232, P = 0.002). The life table was used to evaluate the survival curves and Log-rank test showed that the difference of recurrent time between two groups was statistically significant (P = 0.03).
The key techniques to remove tumor are bleeding control, drilling-out the bone that tumor invaded. Transpterygoid or posterolateral wall of maxillary sinus approach are recommended for tumors that extend to infratemporal fossa. Small and intermediate-sized JNA which have no deep invasion of skull base (RadkowskiIa-II b) have a low morbidity. JNA at Radkowski stage IIc and above have residual and recurrent risk.
介绍青少年鼻咽血管纤维瘤（JNA）切除术手术方式的变化及随访结果。
回顾性分析2002年至2009年间在内镜下治疗的59例JNA患者的临床资料。将患者分为两组：A组（Radkowski I a-II b期）和B组（Radkowsik II c-III b期）。观察并记录肿瘤分期、供血血管、手术时间、并发症及复发情况。
I a期7例，I b期3例，II a期5例，II b期6例，II c期4例，III a期23例，III b期11例。A组（21例）诊断时的平均年龄为23.9岁。平均手术时间为（106.0±43.7）分钟。除3例失访病例外，随访时间为3个月至74个月（中位时间36个月）。B组（38例）诊断时的平均年龄为16.2岁，平均手术时间为（152.9±58.0）分钟。除5例失访病例外，随访时间为3个月至87个月（中位时间25个月）。随访期间，B组有6例复发。B组1例患者发生丘脑梗死，后完全恢复。两组手术时间差异有统计学意义（t = -3.232，P = 0.002）。采用寿命表评估生存曲线，Log-rank检验显示两组复发时间差异有统计学意义（P = 0.03）。
切除肿瘤的关键技术是控制出血、磨除肿瘤侵犯的骨质。对于延伸至颞下窝的肿瘤，推荐经翼突或上颌窦后壁入路。未侵犯颅底深层的中小型JNA（RadkowskiIa-II b期）发病率低。Radkowski IIc期及以上的JNA有残留和复发风险。
