目的 探讨在无动脉栓塞下内镜经鼻入路治疗鼻咽血管纤维瘤的可行性及减少术中出血的策略.方法 对25例鼻咽血管纤维瘤的临床资料进行回顾性分析,包括Ⅱa期3例、Ⅱb期5例、Ⅱc期4例、Ⅲa期13例(Radowski分期).全部病例未行动脉栓塞,均在气管插管全身麻醉控制性低血压下经鼻入路行内镜下血管纤维瘤切除术,其中2例同时行唇龈切口.术中通过开放视野、切除上颌窦后外侧壁及翼突充分显露翼腭窝和颞下窝,及早确认解剖标志和建立安全平面,沿肿瘤周围进行微创分离,提前阻断肿瘤营养血管以及对肿瘤整块切除等方法减少术中出血并切除肿瘤.结果 术中出血量600～1500 ml,无颈内动脉损伤及颅内损伤等并发症.术后随访2～3年,除1例因瘤体包绕视神经有肿瘤残留外,其余24例未发现肿瘤残留及复发.结论 术前动脉栓塞或动脉结扎并非必需,掌握适当的操作技巧是减少术中出血的关键,内镜下切除未行动脉栓塞的鼻咽血管纤维瘤可行.%Objective To explore the feasibility of endoscopic resection without arterial embolism for nasopharyngeal angiofibroma and the strategy of decreasing the bleeding during the operation.Methods The clinical data of twenty-five cases of nasopharyngeal angiofibroma were retrospective analyzed,including 3 cases of Radowski stage Ⅱ a,5 cases of stage Ⅱ b,4 cases of stage Ⅱ c and with 13 cases of stage Ⅲ a.All cases did not receive the arterial embolism,and controlled hypotension were adopted under endoscopic transnasal approach during the tumor resection.Two cases were added the labiogingival incision.During the operation,under the opening vision,cutting out the outside of the infratemporal fossa,and the pterygoid process to adequate exposure the pterygopalatina fossa and infratemporal fossa.Early recognition of anatomical landmarks and establish the safety plane,along the periphery of the tumor to proceed with micro-separation,early blocking tumor nutrient vessels,en bloc resection of the tumor and some other ways to reduce bleeding and tumor resection.Results Amount of bleeding during operation was 600-1500 ml,none of them had internal carotid artery injury and intracranial injury or some other complication.Follow-up 2-3 years was available in all patients,except 1 case with residual of tumor surrounding the optic nerve,the other 24 cases had no residual tumor and relapses.Conclusions The preoperative occlusion and artery ligation may not be needed.Surgical technique is the key to reduce blood loss,and it is feasible to have endoscopic resection of nasopharyngeal angiofibroma with proper operating technique.
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