鼻和鼻窦内翻性乳头状瘤显微手术治疗效果的观察

Effect of microsurgery for nose-sinus inverted papilloma

目的 :探讨显微手术治疗鼻和鼻窦内翻性乳头状瘤的效果。方法 :1995年 1月至 2 0 0 2年 4月显微镜下辅以内窥镜治疗鼻和鼻窦内翻性乳头状瘤 18例 ,男 15例 ,女 3例 ,4 0～ 81岁 ,平均 5 3岁。 1例伴癌变 ,均为单侧病变。首次手术 4例 ,14例曾当作“鼻息肉”手术过 1～ 3次。按照Krokuse方法分级 ,Ⅰ级 (限于鼻腔 ) 1例 ;Ⅱ级 (限于筛窦、上颌窦内侧上部 ) 10例 ;Ⅲ级 (包括上颌窦外侧、下部、额窦、蝶窦 ) 6例 ;Ⅳ级 (侵及鼻和鼻窦外结构 ) 1例 (侵犯鼻泪管 )。手术方法 :局麻 ,3例肿瘤根蒂涉及上颌窦外壁用柯 -陆和鼻腔联合径路 ,余均用鼻腔径路。术后随防 6～ 72月 ,平均 4 2 .7月。结果 :15例 (83% )无复发 ,镜下示黏膜光滑愈合。复发 3例 :1例术后 3月有息肉样增生 ,切除后病检报告为“黏膜炎伴不典型增生”。另 1例分别在术后 12月、2 4月、37月时复发 ,前两次是与首次手术部位不同的异位复发 ,病检报告均为“乳头状瘤复发” ,最后一次为息肉伴鳞状上皮不典型增生。 1例再手术后随访 2年以上 ,未再复发。结论 :1.术前明确诊断有利于内翻性乳头状瘤的根治。单侧病变、CT片上未显示钩突等复合体变异 ,有孤立的骨质增生是诊断乳头状瘤的初步依据 ,术前病理活检可以确诊 ;2 .显微镜下手术复发率与内窥?

Objective: To explore the effect of microsurgery for nose-sinus inverted papilloma. Method: 18 cases(male 15,female 3, 40～81 years old, mean 53 years old)with a lateral nose-sinus inverted papilloma (one case had carcinomatous change)were treated with microsurgery and endoscopic obeseved. As Krouse classification,tumour of one case limited nasal cavity was I grade; of 10 cases sited ethmoid and antrum was Ⅱ grade; of 6 cases in out-lateral or bottom wall of maxillary and frontal or sphenoid sinus was Ⅲ grade; and one case was IV grade that had out-nose invasion in lacrimal tube. 4 cases were first operation and other 14 cases had been operated 1～3 times as 'nasal polyps'. All cases were followed up 6～72 months(mean 42.7months) in postoperation. Result: 15 cases (83%)had not relapse. 3 cases had relapse(17%).Conclusion: Effect of microsurgery for nose-sinus inverted papilloma is equal to that of endoscopic surgery, if pre-operation has a determinately diagnosis according as it hasn′t anatomic abnormity in middle meatus nasi-sinus complex and pathology, it will gain radical cure.