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目的:探讨如何减少青少年鼻咽血管纤维瘤(JNA)术中出血量,以及如何防止术后肿瘤复发的措施与方法。方法:回顾性分析我科1980年2月~2001年12月间收治的45例男性青少年JNA患者的临床资料,将45例患者分为两组,实验组包括术前行颈外动脉结扎患者10例,数字减影血管造影((DSA)血管栓塞术8例;对照组为术前未作任何血管处理的患者(27例)。手术进路经传统或改良的腭间、鼻侧切开及颅面联合进路。术后放疗6例。结果:全部患者术后均随访6~84个月。治愈36例,复发9例,复发率为20.0%,其中有6例经再次手术完全切除肿瘤,3例未完全切除肿瘤,术后追加放疗,随访1~3年无复发。术前颈外动脉结扎、血管栓塞组的术中出血量与对照组比较无统计学意义。结论:①手术进路依肿瘤分期选择,绝大部分手术可经传统或改良的经腭及鼻侧切开进路完成;②术前颈外动脉结扎及血管栓塞组的术中出血量与对照组比较差异无统计学意义;③术中出血量、术后复发与肿瘤分期有关;④肿瘤残瘤复发及晚期患者采用放疗是有效的辅助疗法。
Objective: To explore how to reduce the amount of blood loss in adolescent nasopharyngeal angiofibroma (JNA) and how to prevent recurrence after operation. Methods: Clinical data of 45 male adolescents with JNA admitted to our department from February 1980 to December 2001 were retrospectively analyzed. The 45 patients were divided into two groups. The experimental group included patients who underwent external carotid artery ligation Cases, digital subtraction angiography (DSA) in 8 cases of vascular embolization; control group of patients without any preoperative vascular treatment (27 cases) .The surgical approach through the traditional or modified palatal, nasal and Craniofacial combined approach.Postoperative radiotherapy in 6 cases.Results: All patients were followed up for 6 to 84 months.All 36 cases were cured, 9 cases recurred, the recurrence rate was 20.0%, of which 6 cases were completely resected by reoperation , 3 cases did not complete resection of the tumor, additional radiotherapy after operation, no follow-up of 1 to 3 years follow-up.Preoperative carotid artery ligation, blood loss in the group of vascular embolism compared with the control group was no significant.Conclusion: According to the tumor staging options, most of the surgery can be completed by the traditional or modified via the palate and nasal approach; ② preoperative ligation of the external carotid artery and blood clots in the group of intraoperative blood loss compared with the control group, no statistical difference Significance; ③ intraoperative blood loss, postoperative recurrence and tumor staging; ④ tumor residual tumor complex Hair and advanced patients with radiotherapy is an effective adjuvant therapy.