Antonelli A R, Cappiello J, Di Lorenzo D, Donajo C A, Nicolai P, Orlandini A
ENT Clinic, University of Brescia, Italy.
Laryngoscope. 1987 Nov;97(11):1319-25. doi: 10.1288/00005537-198711000-00014.
Nineteen patients with juvenile nasopharyngeal angiofibroma (JNA) were surgically treated with different techniques from January 1968 through December 1985. Two patients had undergone a previous operation at another hospital; all patients were males (mean age 15.4), and the most common symptom was nasal obstruction (84.2%). Lateral extension into the pterygomaxillary fossa occurred in 14 patients (73.6%), and 2 also had intracranial invasion (10.5%). In five cases, the tumor's cytosol was analyzed for hormonal receptors. Negative values for estrogen and progesterone receptors were obtained, although the content of dehydrotestosterone receptors was highly positive. These results tend to support the hypothesis of JNA's androgen-dependence. The authors emphasize the need of a preoperative staging classification based on clinicoradiological data in selecting the most adequate surgical approach. Tumors with lateral extension into the pterygomaxillary fossa can be easily removed through a midface degloving; large involvement of the infratemporal fossa requires, also, a transzygomatic dissection. In JNAs with intracranial extension a combined intracranial-extracranial approach is advisable.
1968年1月至1985年12月期间，19例青少年鼻咽血管纤维瘤（JNA）患者接受了不同技术的手术治疗。2例患者曾在其他医院接受过手术；所有患者均为男性（平均年龄15.4岁），最常见的症状是鼻塞（84.2%）。14例患者（73.6%）肿瘤向翼腭窝外侧扩展，2例患者（10.5%）还伴有颅内侵犯。5例患者的肿瘤细胞溶质进行了激素受体分析。雌激素和孕激素受体检测为阴性，而脱氢睾酮受体含量呈高度阳性。这些结果倾向于支持JNA雄激素依赖性的假说。作者强调，在选择最恰当的手术方法时，需要基于临床放射学数据进行术前分期分类。向翼腭窝外侧扩展的肿瘤可通过面中部脱套术轻松切除；颞下窝受累范围较大时，还需要进行经颧弓解剖。对于有颅内扩展的JNA，建议采用颅内-颅外联合入路。
