Liaqat Nazneen, Din Israr Ud, Ul Haq Ihtisham, Ullah Shakir, Ahmad Izhar, Khan Imran
Department of Otorhinolaryngology-Head and Neck Surgery, Khyber Teaching Hospital (KTH) Medical Teaching Institute, Peshawar, PAK.
Cureus. 2024 May 21;16(5):e60747. doi: 10.7759/cureus.60747. eCollection 2024 May.
Background Surgical excision is the primary treatment for juvenile nasopharyngeal angiofibroma (JNA), but this procedure is challenging due to its high vascularity and local aggressiveness. Moreover, preoperative embolization is a subject of debate. Objective The objective of this study is to assess the efficacy, safety, and feasibility of endoscope-assisted excision as a surgical intervention for non-embolized advanced JNA. Materials and methods This case series involved six male patients (mean age: 16 years) with JNA, classified as stages Ⅱc to Ⅲb according to the Radkowski classification. None underwent preoperative embolization. Results Two stage Ⅱc cases underwent total endoscopic endonasal excision. One patient with stage Ⅲa and another with stage Ⅲb underwent surgery via an endoscope-assisted sublabial approach. Two patients, one with stage Ⅱc JNA and another with Ⅲb, underwent a two-stage procedure. Postoperative CT scans showed no residual disease at the six-month mark. On average, each procedure required 1.5 units of blood transfusion. One patient experienced intraoperative bleeding, whereas the remaining patients were free of any major complications. The mean operation duration was 175 minutes per procedure. The mean length of stay at the hospital was 3.75 days per procedure. Conclusion Endoscope-assisted or purely endoscopic approaches can be safely and effectively employed for the complete excision of non-embolized advanced JNAs.
手术切除是青少年鼻咽血管纤维瘤（JNA）的主要治疗方法，但由于其血管丰富且具有局部侵袭性，该手术具有挑战性。此外，术前栓塞存在争议。目的：本研究旨在评估内镜辅助切除作为未栓塞晚期JNA手术干预的疗效、安全性和可行性。材料与方法：本病例系列包括6例男性JNA患者（平均年龄：16岁），根据Radkowski分类法分为Ⅱc至Ⅲb期。均未接受术前栓塞。结果：2例Ⅱc期患者接受了全内镜鼻内切除。1例Ⅲa期患者和另1例Ⅲb期患者通过内镜辅助唇下途径进行手术。2例患者，1例为Ⅱc期JNA，另1例为Ⅲb期，接受了两阶段手术。术后6个月的CT扫描显示无残留病灶。平均每次手术需要输注1.5单位血液。1例患者术中出血，其余患者无任何重大并发症。平均手术时间为每次手术175分钟。平均住院时间为每次手术3.75天。结论：内镜辅助或单纯内镜方法可安全有效地用于完全切除未栓塞的晚期JNA。
