Head and Neck Surgery Department, Hôpital Lariboisière, Paris, France.
Otolaryngol Head Neck Surg. 2012 Nov;147(5):958-63. doi: 10.1177/0194599812454394. Epub 2012 Jul 16.
The aim of this study was to review recent management of juvenile nasopharyngeal angiofibroma (JNA) in our institution during the past 10 years and to analyze the shift in surgical paradigm based on the rate of endoscopic approach and Radkowski staging.
Case series with chart review.
The study was conducted from April 2000 to August 2010 in a tertiary care university hospital (Lariboisière, Paris, France).
All patients referred for a JNA were included in the study. Medical files and imaging data were retrospectively analyzed. Surgical management was then evaluated for 2 different periods (group 1, n = 31, consecutive patients operated on from April 2000 to June 2005, and group 2, n = 41, from July 2005 to August 2010).
Seventy-two patients were operated on, with a mean age of 16.25 years (range, 9-33 years). The rate of the endoscopic approach was significantly higher in group 2 than in group 1 (82.9% vs 45%). Rates of recurrence and complications were similar. Recurrences (ie, residual disease growing and treated by redo) were noted in 6 cases or 8.3% (group 1, n = 3; group 2, n = 3; P > .05).
Progress in skull base anatomy, instrumentation, cameras, and surgical strategy allows for expansion of the indications for endoscopic removal of JNA. This approach may have a better outcome in terms of blood loss, hospital stay, and local sequelae. Still, an external approach should be considered only for selected cases due to massive intracranial extension or optic nerve or internal carotid artery entrapment by the tumor.
本研究旨在回顾过去 10 年我们机构中青少年鼻咽血管纤维瘤（JNA）的最新治疗方法，并根据内镜入路和 Radkowski 分期的比率分析手术模式的转变。
病例系列和图表回顾。
这项研究于 2000 年 4 月至 2010 年 8 月在法国巴黎的一家三级保健大学医院（Lariboisière）进行。
所有被转诊为 JNA 的患者均纳入本研究。回顾性分析病历和影像学资料。然后，根据 2 个不同时期（第 1 组，n=31，连续于 2000 年 4 月至 2005 年 6 月手术的患者；第 2 组，n=41，于 2005 年 7 月至 2010 年 8 月手术）评估手术治疗。
共对 72 例患者进行了手术，平均年龄为 16.25 岁（范围为 9-33 岁）。第 2 组内镜入路的比率明显高于第 1 组（82.9%对 45%）。复发率和并发症发生率相似。6 例（8.3%）患者（第 1 组，n=3；第 2 组，n=3；P＞.05）出现复发（即残留肿瘤生长并经再次手术治疗）。
颅底解剖学、器械、摄像机和手术策略的进步使得内镜切除 JNA 的适应证得以扩大。这种方法在出血量、住院时间和局部后遗症方面可能具有更好的效果。但是，由于肿瘤向颅内大量延伸或视神经或颈内动脉受压，仅应考虑对外科手术。
