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目的:探讨3类鼻咽血管纤维瘤(JNA)有效的术式和术中出血的原因。方法:回顾性分析36例JNA患者的临床资料。Ⅰ类肿瘤15例,采用鼻腔入路;Ⅱ类肿瘤18例,采用扩大的上颌窦根治术切口及上颌窦-颞下窝-鼻腔联合入路;Ⅲ类肿瘤3例,采用颅内外联合入路。结果:Ⅰ类肿瘤15例中有14例一次手术完全切除,术后无复发,1例术后复发经同样入路再次手术完全切除;Ⅱ类肿瘤18例中有13例一次切除术后无复发,5例术后复发经二次彻底切除;Ⅲ类肿瘤3例有分叶向颅内深入扩展,未能全切,颅内残余肿瘤补作约40Gy的放疗,效果良好。结论:采用以上3种手术方案可有效切除不同类型的JNA。颅内有残余肿瘤者可辅以放疗。在明视下细致分离肿瘤,妥善止血是手术成败的关键。
Objective: To investigate the effective surgical procedures and causes of intraoperative bleeding in three types of nasopharyngeal angiofibroma (JNA). Methods: The clinical data of 36 patients with JNA were retrospectively analyzed. Ⅰ type of tumor in 15 cases, the use of nasal approach; Ⅱ type of tumor in 18 cases, with an enlarged maxillary sinus incision and maxillary sinus - infratemplasl fossa nasal cavity combined approach; Ⅲ type of tumor in 3 cases, using intracranial and extracranial approach . Results: Among the 15 cases of type Ⅰ tumors, 14 cases were completely surgically removed without any recurrence. One case had recurrent resection by the same approach and were completely resected by surgery. Thirteen of 18 cases of type Ⅱ tumors had no recurrence after one resection , 5 cases of postoperative recurrence by the second complete resection; Ⅲ type of tumor in 3 cases of subepithelial deep expansion to the intracranial, failed to complete resection, intracranial residual tumor make about 40Gy of radiotherapy, the effect is good. Conclusion: The above three kinds of surgical procedures can effectively remove different types of JNA. Intracranial residual tumor may be supplemented with radiotherapy. Careful separation of tumor in clear vision, proper hemostasis is the key to the success of surgery.