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摘要:
目的探讨晚期鼻咽纤维血管瘤的手术策略 方法回顾广东省人民医院耳鼻喉头颈外科2009年~2012年以来的10例Ⅲ期鼻咽纤维血管瘤病例。根据Radkowski分期，Ⅲa期，共4例，行内镜下经中鼻道-下鼻道扩大上颌窦后外侧壁入路切除肿瘤；Ⅲb期，共6例，5例内镜下经中鼻道-下鼻道扩大上颌窦后外侧壁入路切除肿瘤，1例行weber-ferguson加睫下切口经上颌窦前壁入路切除肿瘤；有3例患者选择分期手术。 结果1例Ⅲa期残留，4例Ⅲb期残留，其余完整切除。随访13~70个月，3例残留进展，分别是Ⅲa期1例，Ⅲb期2例，其中2例接受二次手术，1例Ⅲa期完整切除，1例Ⅲb期患者仍残留；另外1例Ⅲb期患者因病变广泛，建议行上颌骨外翻术，患者家属拒绝，后来失访。所有患者均无明显的术后并发症。 结论绝大部分Ⅲ期鼻咽纤维血管瘤可以选择经鼻鼻内镜手术方式，部分可以完整除切，对于残留病例，可以选择密切观察，weber-ferguson加睫下切口经上颌窦前壁入路是切除病变广泛的Ⅲb期鼻咽纤维血管瘤的理想选择。 -
表 1 本组鼻咽纤维血管瘤按Radkowshi分期及预后
Ⅲa Ⅲb 患者 4 6 残留 1 4 残留进展 1 2 再次手术 1 1 分期手术 2 0 术中平均出血量 3180 2600 术前血管栓塞 1 1 术前颈外动脉接扎 1 1 完整切除 3 2 
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