經鼻內視鏡手術切除鼻咽部血管纖維瘤-病例報告

Transnasal Endoscopic Surgery for Juvenile Nasopharyngeal Angiofirboma-Case Report

蘇旺裕(Wang-Yu Su) ； 葉德輝(Te-Huei Yeh) ； 張逸良(Yih-Leong Chang)

《中華民國耳鼻喉科醫學雜誌》 36卷5期 (2001/06) Pp. 304-307

https://doi.org/10.6286/2001.36.5.304

摘要

鼻咽部血管纖維瘤是好發於年輕男性的腫瘤，其病理組織上雖為良性但具有局部侵犯及易復發的特性。傳統治療方式是術前腫瘤血管栓塞後以手術切除。於1996年首次有學者報告以鼻內視鏡方式治療此一腫瘤。本例病患為18歲男性，主訴經常左側鼻塞與自發性左側鼻出血已1年，局部理學檢查可見左側中鼻道後緣有一肉色、表面平滑、外觀與鼻息肉不同之腫塊。因臨床上高度懷疑為血管纖維瘤，故於電腦斷層檢查後，先按排血管攝影並將腫瘤血管栓塞，再以經鼻內視鏡手術切除，追蹤6個月無併發症及復發跡象。經鼻內視鏡手術因無臉部疤痕、傷口癒合速度快且術後疼痛輕微，不啻為治療早期鼻咽部血管纖維瘤之另一選擇。

關鍵字

鼻咽部血管纖維瘤 ； 血管攝影 ； 經動脈血管栓塞 ； 經鼻內視鏡手術切除

並列摘要

Nasopharyngeal angiofibroma occurs most commonly in young males. It is histopathologyically benign, but had a tendency to invade locally and to recur after resecrion. The mainstay of treatment is surgical resection after transarterial embolization (TAE) of the tumor. We present the case of an 18-year-old man who presented with a one year history of left nasal obstruction and recurrent spontaneous left sided epistaxis. On examination, a reddish mass over the left nasal cavity was seen. A CT scan showed a space-occupying lesion over the left nasal cavity extending into the nasopharynx, leading to a presumptive diagnosis of juvenile nasopharyngeal angiofibroma (JAN). Transarterial angiography and embolization were performed and were followed by transnasal endoscopic resection of the tumor. No evidence of recurrence was found during six months of follow-up. Compared to traditional open surgical approaches, endoscopic resection of tumors results in less blood loss, less postoperative pain, healing is more rapid, and facial scars are avoided. With appropriate evaluation and preparation, endoscopic resection is a useful option for the treatment of JNA.

並列關鍵字

nasopharyngeal angiofibroma ； angiography ； transarterial embolization ； transnasal endoscopic resection