Ruiz Jose W, Saint-Victor Sandra, Tessema Belachew, Eloy Jean Anderson, Anstead Amy
University of Miami Center for Sinus and Voice, Department of Otolaryngology, University of Miami, Miller School of Medicine, Miami, FL 33136, USA.
Int J Pediatr Otorhinolaryngol. 2012 Mar;76(3):439-42. doi: 10.1016/j.ijporl.2011.11.005. Epub 2012 Jan 23.
To provide additional support for the use of coblation in the surgical treatment of juvenile nasopharyngeal angiofibroma (JNA) tumors. Coblation radiofrequency has been recently described in endoscopic sinus surgery for polyp and tumor resection from the sinuses to the skull base. This is a case series from our institution in which we safely and successfully treated three adolescent boys with JNA using the coblation assisted technique. The first case was the smallest of the cases (Radkowski stage IB) and was embolized pre-operatively. The second and third cases, both larger in size (Radkowski stage IIC and IIB) did not undergo pre-operative embolization. The total surgical times were 105, 160, and 150 min and the estimated blood losses were 150, 400, and 130 mL, respectively. This yielded a blood loss per minute rate of only 1.4, 2.5, and 0.9 mL/min for the respective cases. None of the three patients required post-operative blood transfusion, nasal packing, or hospitalization of greater than one day. Follow-up showed no complications and no recurrence in these patients. Coblation assisted transnasal endoscopic resection of JNA is a feasible technique that can dissect through and debulk JNA tumor, despite its extreme vascularity. The surgery can be performed with minimal morbidity and low intraoperative blood loss, even with non-embolized tumors up to Radkowski IIC. These finding further support complete resection of JNA tumors using minimally invasive coblation assisted techniques.
为在青少年鼻咽血管纤维瘤（JNA）肿瘤的外科治疗中使用低温等离子消融术提供更多支持。低温等离子体射频最近已被应用于内镜鼻窦手术中，用于从鼻窦到颅底的息肉和肿瘤切除。这是我们机构的一个病例系列，我们使用低温等离子体辅助技术安全且成功地治疗了三名患有JNA的青少年男性。第一例是病例中最小的（Radkowski IB期），术前进行了栓塞。第二例和第三例，尺寸都较大（Radkowski IIC期和IIB期），未进行术前栓塞。总手术时间分别为105、160和150分钟，估计失血量分别为150、400和130毫升。这使得各病例每分钟的失血量仅为1.4、2.5和0.9毫升/分钟。三名患者均无需术后输血、鼻腔填塞或住院超过一天。随访显示这些患者无并发症且无复发。低温等离子体辅助经鼻内镜切除JNA是一种可行的技术，尽管JNA肿瘤血管极其丰富，但仍可通过其进行解剖并减少肿瘤体积。即使对于Radkowski IIC期的未栓塞肿瘤，该手术也可在最小的发病率和低术中失血量的情况下进行。这些发现进一步支持了使用微创低温等离子体辅助技术完全切除JNA肿瘤。
