鼻—鼻窦神经鞘瘤12例临床分析

发布时间：2018-11-14 15:05

【摘要】：目的探讨鼻-鼻窦神经鞘瘤的诊断方法及治疗策略,增强对该病的认识,提高确诊率,减少复发率。方法收集2008年1月-2014年12月吉林大学第二医院耳鼻咽喉头颈外科住院收治并经病理证实的鼻-鼻窦神经鞘瘤12例。从性别、发病年龄、临床表现、病理分型、鼻内镜检查、CT及MRI影像、手术方式等多个方面进行回顾性分析。根据肿物的大小、受累范围,选取不同术式,并进行术后随访,在随访期间定期行鼻内镜检查及清理术腔,必要时复查鼻窦CT或MRT,以监测有无复发。结果鼻-鼻窦神经鞘瘤12例,男4例,女8例。年龄11~76岁,病程1个月~8年。11例发生于单侧,其中3例仅累及鼻腔,5例仅累及鼻窦,3例鼻腔、鼻窦均累及;1例发生于双侧。主要临床表现为持续性鼻塞(7/11)、头痛(3/11);少数患者有面部麻木(2/11),也可出现眼部症状如眼球突出、复视及视力下降等(3/11),早期发现者无症状(1/11);鼻内镜表现为表面光滑肿物灰白色(3/11)、粉红色(3/11)或囊肿样物(1/11)。所有病例CT均表现为密度均匀软组织影,5例鼻窦CT表现有骨质破坏;2例侵犯颅底,其中1例并发脑脊液鼻漏。11例经鼻内镜手术达临床治愈;1例行鼻内镜联合鼻侧切开术,初次手术后2年复发,在鼻内镜下再次行手术治疗,目前已随访1年未再发。病理结果12例均为良性。2例术前依靠常规病理联合免疫组化确诊。8例术中行快速病理,可确定肿瘤为间叶组织来源,考虑神经鞘瘤,术后经免疫组化确诊。仅2例术后常规病理诊断为神经鞘瘤。结论1.鼻-鼻窦神经鞘瘤可分为良性和恶性,恶性罕见。2.鼻-鼻窦神经鞘瘤好发于单侧。3.鼻-鼻窦神经鞘瘤的诊断需综合临床表现、体征、鼻内镜检查及鼻窦CT或MRI影像,最后诊断依靠病理,常规病理常不能确诊,免疫组织化学是确诊的金标准。4.鼻-鼻窦神经鞘瘤的治疗首选手术。神经鞘瘤对放化疗不敏感,唯一有效的治疗方法是手术切除肿瘤。术式选择主要为鼻内镜微创手术,必要时联合开放式手术。
[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.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R739.62

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