复发性青少年鼻咽血管纤维瘤：两例强调随访与分期在外科规划中的作用

文献信息

中文摘要

背景： 青少年鼻咽血管纤维瘤（JNA）是一种罕见的、良性但局部侵袭性的血管性肿瘤，好发于青少年男性。尽管术前栓塞联合内镜下切除术仍是首选治疗，但复发仍是一个挑战，常由切除不彻底或随访依从性差所致。
病例介绍： 我们报告两例青少年男性复发性JNA病例，每例均突显了一个不同的可改变复发危险因素。病例1为一名21岁患者，既往接受过切除术且术后随访不佳，再次就诊时表现为累及中央颅底的Radkowski IIIA期病变。病例2为一名18岁患者，最初被误诊为鼻息肉，术后4个月内复发后确诊为JNA。两名患者均接受术前栓塞，随后采用经鼻-经翼突入路行内镜下鼻内切除术。组织病理学证实两例均为复发性JNA。术后3个月MRI显示无残留或复发病变证据。
结论： 这些病例强调了准确初始诊断、正确分期和结构化术后监测在降低JNA复发风险中的关键作用。多学科协作、患者教育以及影像引导的随访方案至关重要，尤其是在诊断延迟和依从性挑战普遍存在的资源受限环境中。

英文摘要

BACKGROUND: Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign but locally aggressive vascular tumor affecting adolescent males. While endoscopic resection with preoperative embolization remains the treatment of choice, recurrence remains a challenge, often driven by incomplete excision or poor follow-up adherence.
CASE PRESENTATION: We report two cases of recurrent JNA in adolescent males, each highlighting a different modifiable risk factor for recurrence. Case 1 involved a 21-year-old with prior resection and poor postoperative follow-up, who re-presented with Radkowski Stage IIIA disease involving the central skull base. Case 2 involved an 18-year-old initially misdiagnosed with a nasal polyp, later confirmed as JNA after recurrence within 4 months of surgery. Both patients underwent preoperative embolization followed by endoscopic endonasal resection using a transnasal-transpterygoid approach. Histopathology confirmed recurrent JNA in both cases. Postoperative MRI at 3 months showed no evidence of residual or recurrent disease.
CONCLUSION: These cases underscore the critical role of accurate initial diagnosis, proper staging, and structured postoperative surveillance in reducing recurrence risk in JNA. Multidisciplinary care, patient education, and imaging-guided follow-up protocols are essential, especially in resource-constrained settings where diagnostic delays and adherence challenges are prevalent.