內視鏡治療鼻腔鼻竇血管性腫瘤回溯性分析：單一醫學中心經驗

背景：臨床上血管性鼻腔鼻竇腫瘤並不常見，可能造成流鼻血或鼻塞等症狀。而鄰近顱底或眼部的腫瘤可能造成神經功能損傷或影響視力，腫瘤本身富含的血管構造也造成治療上的困難。我們回溯性分析本部的個案及治療經驗，希望增進本土治療此類腫瘤的經驗。方法：根據本院品質管理中心臨床資訊科資料，自2005年1月至2021年12月間，共收集31名鼻腔血管瘤個案，分析性別比、平均年齡、原發部位、治療方式及預後。結果：31名個案分別為鼻咽血管纖維瘤（nasopharyngeal angiofibroma）8例、血管瘤（hemangioma）19例、血管外皮細胞瘤（hemangiopericytoma）2例、脈絡球瘤（glomus tumor）1例及細胞性血管纖維瘤（cellular angiofibroma）1例。男性19名，女性12名，以流鼻血和鼻塞為主要症狀，病患均接受內視鏡手術腫瘤切除，9名患者接受術前栓塞（feeding vessel embolization）。3名血管纖維瘤患者未能在首次手術後痊癒，2名患者首次手術後3年復發接受再次手術，1名術後明顯殘存腫瘤，但逐年追蹤腫瘤縮小。其餘患者至本研究結束時無復發。結論：鼻腔鼻竇血管性腫瘤應避免術前切片造成出血，必要時術前進行血管栓塞術，以減少術中大出血的機會。血管纖維瘤常發生於男性青少年，而血管瘤則好發於成年人，多數血管性腫瘤透過內視鏡手術可完全摘除，但當腫瘤過大可能造成功能性損傷時，應在保存功能優先的考量下階段性手術。

關鍵字

angiofibroma ； endoscopic sinus surgery ； hemangioma（血管纖維瘤；內視鏡手術；血管瘤）

並列摘要

BACKGROUND: Vascular sinonasal tumor is rare. Patients with this tumor typically present with a unilateral epistaxis or nasal obstruction. Large tumors with orbital or intracranial extension could result in neurological deficits. These large tumors are often a surgical challenge. METHODS: From January 2005 to September 2021, we retrospectively enrolled patients who had undergone surgical treatment for sinonasal vascular tumors in our institute. We further analyzed statistics of their gender, age, primary site, treatment, and outcome. RESULTS: We studied a total of 31 patients: 19 males and 12 females. Among these cases, we found 8 angiofibroma, 19 hemangioma, 2 hemangiopericytoma, 1 glomus tumor, and 1 cellular angiofibroma. Most patients presented with a unilateral epistaxis and nasal obstruction. All of them underwent endoscopic surgical excision of their tumors. Nine patients received pre-operative arterial embolization. Two angiofibroma patients recurred 3 years after the primary surgery and received a revision surgery. Another angiofibroma patient had grossly residual tumor and kept annual follow-up.Other patients remain disease free until this study finished. CONCLUSIONS: Biopsy is apparently contraindicated in vascular sinonasal tumors. Pre-operative arterial embolization minimizes intraoperative bleeding, offering a better field for operation. Juvenile angiofibroma occurs mostly in adolescent male. More than half of hemangioma patients were adult female. For large or unresectable vascular tumors, functional preserve appears to be the first option for management. Endoscopic resection cures most sinonasal vascular tumors as observed in our dataset.

並列關鍵字

angiofibroma ； endoscopic sinus surgery ； hemangioma

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內視鏡治療鼻腔鼻竇血管性腫瘤回溯性分析：單一醫學中心經驗

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