原发性青少年鼻咽血管纤维瘤的术前栓塞：颈内动脉分支栓塞是否必要？
Preoperative Embolization of Primary Juvenile Nasopharyngeal Angiofibroma: Is Embolization of Internal Carotid Artery Branches Necessary?
机构信息
Department of Radiology, Eye and ENT Hospital, Fudan University, Shanghai, 200031, China.
Department of Otolaryngology, Eye and ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
出版信息
Cardiovasc Intervent Radiol. 2023 Aug;46(8):1038-1045. doi: 10.1007/s00270-023-03483-1. Epub 2023 Jul 10.
PURPOSE
To determine the effects of blood supply from internal carotid artery (ICA) on the surgical outcomes of primary juvenile nasopharyngeal angiofibroma (JNA) after transarterial embolization (TAE).
METHODS
A retrospective analysis was performed on primary JNA patients who underwent TAE and endoscopic resection in our hospital between December 2020 and June 2022. The angiography images of these patients were reviewed, and then they were divided into ICA + external carotid artery (ECA) feeding group and ECA feeding group according to whether the ICA branches were part of the feeding arteries. Tumors in ICA + ECA feeding group were fed by both ICA and ECA branches, while tumors in ECA feeding group were fed by ECA branches alone. All patients underwent tumor resection immediately after ECA feeding branches embolization. None of the patients underwent ICA feeding branches embolization. Data on demographics, tumor characteristics, blood loss, adverse events, residual and recurrence were collected, and case-control analysis was performed for the two groups. Differences in characteristics between the groups were tested using Fisher's exact and Wilcoxon tests.
RESULTS
Eighteen patients were included in this study: nine in ICA + ECA feeding group and nine in ECA feeding group. The median blood loss was 700 mL (IQR 550-1000 mL) in ICA + ECA feeding group versus 300 mL (IQR 200-1000 mL) in ECA feeding group, with no significant statistical difference (P = 0.306). Residual tumor was found in one patient (11.1%) in both groups. Recurrence was not observed in any patient. There were no adverse events from embolization and resection in either group.
CONCLUSION
The results of this small series suggest that the presence of blood supply from ICA branches in primary JNA has no significant effect on intraoperative blood loss, adverse event, residual and postoperative recurrence. Therefore, we do not recommend routine preoperative embolization of ICA branches.
LEVEL OF EVIDENCE
Level 4, Case-control.
目的
探讨颈内动脉（ICA）供血对青少年鼻咽血管纤维瘤（JNA）经动脉栓塞（TAE）后手术效果的影响。
方法
回顾性分析 2020 年 12 月至 2022 年 6 月在我院接受 TAE 联合内镜切除术的原发性 JNA 患者。分析患者的血管造影图像，并根据 ICA 分支是否为供血动脉的一部分，将其分为颈内动脉+颈外动脉（ECA）供血组和单纯 ECA 供血组。ICA+ECA 供血组肿瘤由 ICA 和 ECA 分支共同供血，而 ECA 供血组肿瘤仅由 ECA 分支供血。所有患者均在 ECA 供血分支栓塞后立即进行肿瘤切除术，未行 ICA 供血分支栓塞。收集患者的一般资料、肿瘤特征、术中出血量、不良事件、肿瘤残留及复发等数据，并对两组进行病例对照分析。采用 Fisher 确切概率法和 Wilcoxon 秩和检验比较两组间的差异。
结果
本研究共纳入 18 例患者，其中 ICA+ECA 供血组 9 例，ECA 供血组 9 例。ICA+ECA 供血组的术中出血量中位数为 700 mL（IQR 5501000 mL），ECA 供血组为 300 mL（IQR 2001000 mL），差异无统计学意义（P=0.306）。两组均有 1 例（11.1%）患者有肿瘤残留。两组均无复发。两组均无栓塞及切除相关不良事件发生。
结论
本小样本研究结果提示，原发性 JNA 存在 ICA 分支供血对术中出血量、不良事件、肿瘤残留及术后复发无显著影响，因此不推荐常规行 ICA 分支术前栓塞。
证据等级
4 级，病例对照。
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