Management of Pterygoid Venous Plexus Hemorrhage during Resection of a Large Juvenile Nasopharyngeal Angiofibroma: A Review of 27 Cases
Management of Pterygoid Venous Plexus Hemorrhage during Resection of a Large Juvenile Nasopharyngeal Angiofibroma: A Review of 27 Cases
复制标题
幼年大型鼻咽血管纤维瘤切除术中翼状静脉丛出血27例的处理
DOI：
10.1177/014556131309200513
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Lan Shuzhan
中科院分区：
文献类型：
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作者：
Lin Chang;Yi Zixiang;Fang Zheming;Li Gongbiao;Li Zhichun;Zhang Rong;Zhou Aidong;Lan Shuzhan
我们回顾了27例在切除大型(Fisch III或IV型)青少年鼻咽血管纤维瘤(JNA)过程中发生出血的病例。在这组患者中，16名患者患有III型JNA，11名患者患有IV型肿瘤。在切除这些DNA的过程中，出血的程度在不同的患者之间差别很大。III型失血量为200~5000ml(平均1800)，IV型为700~8000ml(平均2850)。其中5例，术中观察和影像资料均提示翼静脉丛(PVP)受损是导致出血的重要因素。PVP与海绵窦、眼静脉、上颌静脉和面静脉相通，这些静脉之间不存在瓣膜。在JNA较大的患者中，PVP通常被肿瘤压缩或粘连。在取出JNA的过程中，如果PVP严重受损，出血可能会非常严重。因此，应采用合适的手术入路和适当的止血程序，以尽可能有效地预防或处理PVP出血。我们还更详细地描述了5例典型的JNA切除，其中3例涉及PVP损伤，2例不涉及PVP损伤。
We retrospectively reviewed the cases of 27 patients who experienced intraoperative bleeding during resection of a large (Fisch type III or IV) juvenile nasopharyngeal angiofibroma (JNA). Of this group, 16 patients had a type III JNA and 11 had a type IV tumor. The degree of hemorrhaging during excision of these JNAs varied greatly among individual patients. The amount of blood lost ranged from 200 to 5,000 ml (mean: 1,800) in the type III cases and from 700 to 8,000 ml (mean: 2,850) in the type IV cases. In 5 of these cases, both intraoperative observations and imaging data suggested that an important factor in the blood loss was damage to the pterygoid venous plexus (PVP). The PVP communicates with the cavernous sinus, ophthalmic vein, maxillary vein, and facial vein; no valve exists between these veins. In patients with a large JNA, the PVP is usually compressed by or adherent to the tumor. When a PVP is seriously damaged during removal of a JNA, hemorrhaging can be very profuse. Therefore, a suitable surgical approach and appropriate hemostatic procedures should be used to prevent or manage PVP hemorrhage as effectively as possible. We also describe in greater detail 5 typical cases of JNA excision that did (n = 3) and did not (n = 2) involve PVP damage.