鼻内镜手术治疗额窦内翻性乳头状瘤

Endoscopic management of the inverted papilloma in frontal sinus

目的探讨鼻内镜手术治疗侵及额窦的内翻性乳头状瘤(inverted papilloma,IP)的疗效。方法回顾分析过去5年内所完成的127例鼻内镜手术治疗的IP病例,共有11例IP侵及额窦,其中有6例肿瘤基底部位于前筛内,采用DrafⅠ型手术治疗；5例IP的基底部位于额窦口及额窦内,3例采用DrafⅡ型手术,另外2例肿瘤广泛波及额隐窝、额窦,并且突破额窦间隔突入对侧额窦,采用DrafⅢ型手术(改良Lothrop术)。结果术后随访1．5～5．5年,平均2．5年,有2例复发。结论鼻内镜手术是一种安全有效的处理额窦内IP的方法,认真选择适应证,肿瘤基底部位的仔细处理和密切的术后随访对治疗成功至关重要。

OBJECTIVE To demonstrate the potentials and limitations of endoscopic procedures employed for treatment of inverted papilloma（IP） involved frontal sinuses. METHODS The clinical data of 127 patients with nasal IP treated in the past 5 years were retrospectively analyzed. IP was involved frontal sinuses in 11 cases. According to the origin of the tumor, three types of resection,Draf Ⅰ,DrafⅡ,DrafⅢ,were used. Draf Ⅰwas performed to resect the tumor in 6 cases with IP origin in anterior ethmoid and extrusion into frontal sinus; Draf Ⅱ in 3 cases with tumor origin in the frontal sinus; Draf Ⅲ in 2 cases with tumor involved both frontal sinus extensively. RESULTS Recurrences was observed in 2 cases after a mean follow-up of 2.5 （range 1.5 to 5.5） years. CONCLUSION Our experience confirms that endoscopic surgery is an effective and safe method for treatment of IPs with frontal sinus involvement. Strict selection of proper patients,meticulous use of subperiosteal dissection in the involved areas,and regular follow-up evaluation are key elements for success.