Endoscopic surgery for juvenile angiofibroma: When and how
Endoscopic surgery for juvenile angiofibroma: When and how
复制标题
DOI：
10.1097/00005537-200305000-00003
复制
发表时间：
2003-05-01
期刊：
影响因子：
2.6
通讯作者：
Antonelli, AR
中科院分区：
文献类型：
--
作者：
Nicolai, P;Berlucchi, M;Antonelli, AR
目的/假设：近年来，鼻内窥镜手术的适应症，最初引入治疗炎症性疾病，已扩大到包括良性和恶性肿瘤病变的选择情况。本研究的目的是确定内窥镜手术治疗中小型青少年血管纤维瘤的疗效。研究设计：回顾性研究。研究方法：我们回顾了1994年1月至2000年4月期间15例幼年血管纤维瘤患者的临床记录和术前术后影像学研究，这些患者在栓塞后接受了内镜治疗。对所有患者进行前瞻性随访，定期进行内镜和磁共振成像评价（第一年每4个月，随后每6个月）。结果如下：根据1989年报道的分期系统，有2例I型，9例II型，3例IIIA型，1例IIIB型青少年血管纤维瘤。血管造影显示，11例患者的血管供应为单侧，4例为双侧。术中失血量范围为80 - 600 mL（平均失血量为372 mL）。在随访期间（范围，24 - 93个月;平均随访时间，50个月[SD +/-19.9个月]），只有1例患者在磁共振成像上显示残留病变，直径为16 mm，在术后24个月检测到。结论：内窥镜入路是一种安全有效的技术，可以切除小型和中型青少年血管纤维瘤（不广泛累及颞下窝和海绵窦），发病率低。晚期病变更适合采用外部入路治疗。
Objectives/Hypothesis: In recent years, the indications for endoscopic surgery of the sinonasal tract, originally introduced for the treatment of inflammatory diseases, have been expanded to include selected cases of benign and malignant neoplastic lesions. The aim of the present study was to establish the efficacy of endoscopic surgery in the management of small and intermediate-sized juvenile angiofibromas. Study Design: Retrospective study. Methods: We reviewed the clinical records and the preoperative and postoperative imaging studies of 15 patients with juvenile angiofibroma who were treated with an endoscopic approach after embolization in the period from January 1994 to April 2000. All patients were prospectively followed by endoscopic and magnetic resonance imaging evaluations performed at regular intervals (every 4 months during the first year and, subsequently, every 6 months). Results: According to a staging system reported in 1989, there were two patients with a type I, nine with a type II, three with a type IIIA, and one with a type IIIB juvenile angiofibroma. Angiography demonstrated that the vascular supply was strictly unilateral in 11 patients and bilateral in 4. Intraoperative blood loss ranged from 80 to 600 mL (mean blood loss, 372 mL). During follow-up (range, 24-93 mo; mean follow-up, 50 mo [SD +/- 19.9 mo]), only one patient presented a residual lesion on magnetic resonance imaging, which was 16 mm in diameter and was detected 24 months after surgery. Conclusions: The endoscopic approach is a safe and effective technique that allows removal of small and intermediate-sized juvenile angiofibromas (without extensive involvement of the infratemporal fossa and cavernous sinus) with a low morbidity. Advanced lesions are more appropriately treated by external approaches.