青少年鼻咽血管纤维瘤(JNA)是最神秘的,耳鼻喉科医师遇到的血性肿瘤,头颈外科医生,神经外科医生,还有麻醉师.JNA很少见,良性,高血管性肿瘤倾向于侵袭性局部侵袭1手术,开放式或内窥镜检查,去除生长是JNA的主要治疗选择。历史上,手术切除与大量,快速失血,传统上通过输血和故意低血压来管理。采用多模式血液保护策略的预防性管理应该是JNA患者围手术期护理的基本标准。我们描述了一种现代而全面的方法来管理高级别JNA肿瘤患者。这包括手术策略,如抢先颈外动脉栓塞,内镜手术入路,和分阶段的行动,以及麻醉策略,包括抗纤溶治疗和急性等容血液稀释。这些手术,曾经是大量输血的代名词,可能在没有异体输血的情况下进行,或者故意低血压.本文作者从多学科患者血液管理(PBM)的角度重新审视了JNA管理的围手术期方法。
Juvenile nasopharyngeal angiofibromas are one of the most enigmatic, bloody tumors encountered by otorhinolarygnologists, head and neck surgeons, neurosurgeons, and anesthesiologists. Juvenile nasopharyngeal angiofibromas are rare, benign, highly vascular tumors with a propensity towards aggressive local invasion. Surgery, open or endoscopic, to remove the growth is the primary treatment of choice for Juvenile nasopharyngeal angiofibromas. Historically, surgical resection was associated with massive, rapid blood loss, traditionally managed by blood product transfusion and deliberate hypotension. Preventative management employing multimodal blood conservation strategies should be an essential standard of perioperative care for patients with Juvenile nasopharyngeal angiofibromas.
We describe a contemporary and comprehensive approach in the management of patients with high grade Juvenile nasopharyngeal angiofibromas. This includes surgical strategies such as preemptive external carotid artery embolization, endoscopic surgical approach, and staged operations, as well as anesthetic strategies including antifibrinolytic therapy and acute normovolemic hemodilution. These surgeries, once synonymous with massive transfusion, may potentially be performed without allogeneic blood transfusion, or deliberate hypotension.
Using a
case series, the authors introduce a contemporary approach to multimodal, multidisciplinary blood conservation strategies for Juvenile nasopharyngeal angiofibromas surgery.
Here in the authors report on an updated contemporary perioperative clinical approach to patients with Juvenile nasopharyngeal angiofibromas. From an anesthetic perspective, we describe the successful use of normal hemodynamic goals, restrictive transfusion strategy, antifibrinolytic therapy, autologous normovolemic hemodilution, and early extubation in the care of three adolescent males with highly invasive tumors. We demonstrate that new surgical and anesthetic strategies have yielded a significant decrease in intraoperative blood loss and eliminated the need for transfusion of autologous red blood cells, which enable improved outcomes.
The perioperative approach to elective surgery for Juvenile nasopharyngeal angiofibromas management is presented from a multidisciplinary patient blood management perspective.