ỨNG DỤNG KỸ THUẬT MỔ 4 TAY TRONG PHẪU THUẬT NỘI SOI LẤY U SỢI MẠCH VÒM MŨI HỌNG

Abstract

Background: Surgical removal of Juvenile Nasopharyngeal Angiofibroma (JNA) is challenging because of the tumor’s intricate blood supply and the complex anatomy of the surrounding structures, such as the pterygopalatine fossa, infratemporal fossa, and skull base. Endoscopic surgery offers a minimally invasive approach that improves visualization, preserves bone integrity, and lowers the risks of complications and recurrence. Objective: The article review staging of the tumor and outcomes of surgical approach to remove JNA. The application of the four-arm surgery technique and preoperative embolization measures are discussed. Method: We conducted a prospective study of 34 cases of JNA at the ENT Hospital of HCM city from July 2019 to July 2023. 30 cases were embolized 24 - 48 hours before surgery. Result: According to Andrews' classification, there were 6 cases of stage I, 22 cases of stage II, 3 cases of stage IIIA and stage IIIB. During surgery, there were 21 cases with blood loss less than 500 ml, 7 cases with blood loss from 500-1000 ml and 6 cases with blood loss more than 1000 ml, 7 cases requiring blood transfusion. Conclusion: Endoscopic surgery to remove JNA has the advantage of avoiding external scars and craniofacial deformities in young patients but also controlling the spreading and distant parts of the tumor but also controls blood loss well, shortens surgery time, and has a gentle postoperative period. The 4-hand surgery technique is suitable for endoscopic surgery to remove JNA.