【摘要】：目的探討鼻-鼻竇神經(jīng)鞘瘤的診斷方法及治療策略,增強(qiáng)對該病的認(rèn)識,提高確診率,減少復(fù)發(fā)率。方法收集2008年1月-2014年12月吉林大學(xué)第二醫(yī)院耳鼻咽喉頭頸外科住院收治并經(jīng)病理證實(shí)的鼻-鼻竇神經(jīng)鞘瘤12例。從性別、發(fā)病年齡、臨床表現(xiàn)、病理分型、鼻內(nèi)鏡檢查、CT及MRI影像、手術(shù)方式等多個方面進(jìn)行回顧性分析。根據(jù)腫物的大小、受累范圍,選取不同術(shù)式,并進(jìn)行術(shù)后隨訪,在隨訪期間定期行鼻內(nèi)鏡檢查及清理術(shù)腔,必要時復(fù)查鼻竇CT或MRT,以監(jiān)測有無復(fù)發(fā)。結(jié)果鼻-鼻竇神經(jīng)鞘瘤12例,男4例,女8例。年齡11~76歲,病程1個月~8年。11例發(fā)生于單側(cè),其中3例僅累及鼻腔,5例僅累及鼻竇,3例鼻腔、鼻竇均累及;1例發(fā)生于雙側(cè)。主要臨床表現(xiàn)為持續(xù)性鼻塞(7/11)、頭痛(3/11);少數(shù)患者有面部麻木(2/11),也可出現(xiàn)眼部癥狀如眼球突出、復(fù)視及視力下降等(3/11),早期發(fā)現(xiàn)者無癥狀(1/11);鼻內(nèi)鏡表現(xiàn)為表面光滑腫物灰白色(3/11)、粉紅色(3/11)或囊腫樣物(1/11)。所有病例CT均表現(xiàn)為密度均勻軟組織影,5例鼻竇CT表現(xiàn)有骨質(zhì)破壞;2例侵犯顱底,其中1例并發(fā)腦脊液鼻漏。11例經(jīng)鼻內(nèi)鏡手術(shù)達(dá)臨床治愈;1例行鼻內(nèi)鏡聯(lián)合鼻側(cè)切開術(shù),初次手術(shù)后2年復(fù)發(fā),在鼻內(nèi)鏡下再次行手術(shù)治療,目前已隨訪1年未再發(fā)。病理結(jié)果12例均為良性。2例術(shù)前依靠常規(guī)病理聯(lián)合免疫組化確診。8例術(shù)中行快速病理,可確定腫瘤為間葉組織來源,考慮神經(jīng)鞘瘤,術(shù)后經(jīng)免疫組化確診。僅2例術(shù)后常規(guī)病理診斷為神經(jīng)鞘瘤。結(jié)論1.鼻-鼻竇神經(jīng)鞘瘤可分為良性和惡性,惡性罕見。2.鼻-鼻竇神經(jīng)鞘瘤好發(fā)于單側(cè)。3.鼻-鼻竇神經(jīng)鞘瘤的診斷需綜合臨床表現(xiàn)、體征、鼻內(nèi)鏡檢查及鼻竇CT或MRI影像,最后診斷依靠病理,常規(guī)病理常不能確診,免疫組織化學(xué)是確診的金標(biāo)準(zhǔn)。4.鼻-鼻竇神經(jīng)鞘瘤的治療首選手術(shù)。神經(jīng)鞘瘤對放化療不敏感,唯一有效的治療方法是手術(shù)切除腫瘤。術(shù)式選擇主要為鼻內(nèi)鏡微創(chuàng)手術(shù),必要時聯(lián)合開放式手術(shù)。
[Abstract]:Objective to explore the diagnostic methods and treatment strategies of naso-paranasal neurilemmoma, to enhance the understanding of the disease, to improve the diagnosis rate and to reduce the recurrence rate. Methods from January 2008 to December 2014, 12 cases of nasolaryngopharyngeal neurilemmoma proved pathologically were collected from the second Hospital of Jilin University. Sex, age, clinical manifestations, pathological types, nasal endoscopy, CT and MRI images, surgical methods and other aspects were retrospectively analyzed. According to the size of the tumor and the extent of involvement, different surgical procedures were selected and followed up. During the follow-up period, nasal endoscopy was performed regularly and the cavity was cleaned up. If necessary, the sinus CT or MRT, were re-examined to monitor the recurrence. Results there were 12 cases of naso-paranasal neurilemmoma, including 4 males and 8 females. The course of disease ranged from 1 month to 8 years old, 11 cases occurred on one side, 3 cases only involved nasal cavity, 5 cases only involved sinuses, 3 cases involved nasal cavity, 3 cases involved sinuses, and 1 case occurred on both sides. The main clinical manifestations were persistent nasal obstruction (7 / 11), headache (3 / 11); A few patients had facial numbness (2 / 11), eye symptoms such as exophthalmos, diplopia and vision loss (3 / 11), and early discoverers were asymptomatic (1 / 11). Nasal endoscopy showed a smooth, grayish white (3 / 11), pink (3 / 11) or cyst-like (1 / 11). All cases showed homogeneous soft tissue density in CT, bone destruction in CT in 5 cases, skull base invasion in 2 cases, cerebrospinal fluid rhinorrhea in 1 case, and clinical cure in 11 cases by endoscopic sinus surgery. One case was treated with nasal endoscopy combined with lateral rhinotomy, which recurred 2 years after the first operation and was treated again under nasal endoscope. 12 cases were benign, 2 cases were diagnosed by routine pathology combined with immunohistochemistry before operation, 8 cases were confirmed by rapid pathology during operation, the tumor was identified as mesenchymal tissue origin and neurilemmoma was considered, and the diagnosis was confirmed by immunohistochemistry after operation. Only 2 cases were diagnosed as neurilemmoma by routine pathology. Conclusion 1. Rhino-paranasal neurinoma can be divided into benign and malignant, malignant rare. 2. Nasal-paranasal neurilemmoma is prone to occur on one side. The diagnosis of naso-paranasal neurilemmoma needs to be integrated with clinical manifestations, signs, nasal endoscopy and CT or MRI images of paranasal sinuses. The final diagnosis depends on pathology, which is often not confirmed by routine pathology. Immunohistochemistry is the gold standard for diagnosis. 4. Surgery is the first choice for the treatment of nasal-paranasal neurilemmoma. Neurilemmoma is insensitive to radiotherapy and chemotherapy, the only effective treatment is surgical resection of the tumor. The main choice of operation was endoscopic minimally invasive surgery, combined with open surgery if necessary.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R739.62

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