以內視鏡手術切除鼻咽部血管纖維瘤－晚期病例仍可適用

Endoscopic Surgery for Nasopharyngeal Angiofibroma-Eligible for Late Staged Tumor

邱盛璋(Sheng-Chang Chiu) ； 陳穆寬(Mu-Kuan Chen) ； 李國維(Kuo-Wei Lee) ； 溫永頌(Yung-Sung Wen) ； 張正權(Cheng-Chuan Chang)

《台灣耳鼻喉頭頸外科雜誌》 38卷6期 (2003/12) Pp. 247-251

https://doi.org/10.6286/2003.38.6.247

摘要

背景：血管纖維瘤是一種少見、良性但是高血管性的腫瘤，一般發生在年輕男性較多。其治療的原則以手術切除為主。相繼有學者以鼻內視鏡手術方式來治療鼻咽部血管纖維瘤，其復發率約為0%到55%。一般是處理早期的病例，然而針對晚期病例則報告不多。本篇旨在討論以內視鏡手術的方式來治療血管纖維瘤，其中包括3名晚期病例。
方法：彰化基督教醫院耳鼻喉科近5年內共有7名因鼻咽部血管纖維瘤接受手術，其手術方法皆為內視鏡手術。性別均為男性，年齡分佈為11歲至37歲，平均年齡為19.7歲。依據1983年Fisch的分期，第一期有4例，第三期有1例，第四期有2例。術前皆安排電腦斷層或核磁共振，其中3名並給予術前的血管攝影及栓塞。
結果：這7名患者皆以內視鏡手術的方式將整個腫瘤切除。術後追蹤時間12至68個月，平均追蹤33.5個月，除1例晚期患者（表1例3）在第28個月於門診追蹤時發現有復發的情形並施行第二次內視鏡手術外，其餘並無復發的情形產生。
結論：根據我們初步的報告顯示，以內視鏡手術的方式來處理鼻咽部血管纖維瘤，除1例復發外，其餘的病例均無復發的現象。在較晚期的病例中，術前先做栓塞可降低術中的出血量及提高手術的成功率。因此，對於鼻咽部血管纖維瘤，經鼻內視鏡手術應是一種不錯的方法。

關鍵字

血管纖維瘤 ； 內視鏡 ； 鼻咽部腫瘤

並列摘要

BACKGROUND: Nasopharyngeal angiofibroma is a rare, benign but highly vascular tumor. It is an aggressively local invasive les ion and often occurs in adolescent males. Surgery is the most effective method of the treatment for nasopharyngeal angiofibroma. Many authorities reporting endoscopic treatment of early nasopharyngeal angiofibroma showed an excellent result, but not many relevant articles issued on the topic of endoscopic surgery for advanced nasopharyngeal angiofibroma. In this article, we report endoscopic surgery for nasopharyngeal angiofibroma; including advanced ones.
METHOD: Seven patients with nasopharyngeal angiofibroma were treated with endoscopic surgery during the last 5 years at Changhua Christian Hospital. The patients are all males. Their ages distribute between 11 and 37 years old and the average is 19.7 years old. According to the classification of Fisch in 1983, 4 patients are stage Ⅰ; 1 patient on stage Ⅲ; 2 patients on stage Ⅳ. All the patients have been arranged for CT or MRI before operation and 3 patients of them have been arranged for angiography and arterial embolization.
RESULTS: All the tumors have been removed by endoscopic surgery. The patients have been routinely followed up from 12 to 68 months and the follow-up average is 33.5 months. We find one recurrence in this series up to now.
CONCLUSIONS: According to our report, endoscopic surgery for early or advanced angiofibromas give a good result. In advanced cases, arterial embolization before operation can reduce blood loss during surgery thus increase the successful rate of the operation. So, endoscopic surgery for angiofibroma is an acceptable and effective method.

並列關鍵字

angiofibroma ； endoscope ； nasopharyngeal neoplasms