鼻及鼻窦内翻性乳头状瘤的诊治

Management of nasal inverted papilloma

目的比较不同术式治疗鼻及鼻窦内翻性乳头状瘤的疗效。方法分析163例该病病例,按不同的术式分鼻外进路组,单纯鼻内镜组,鼻内镜联合柯-陆进路组;按病变范围不同分Ⅰ期79例,Ⅱ期68例,Ⅲ期12例,Ⅳ期4例;按上皮细胞的增生异型程度分轻(128例)、中(26例)、重度不典型增生(9例)。术后随访6～64个月,比较复发率。结果临床分期相同的患者三种术式疗效无显著性差异(P>0.05)。总复发率11.04%(18/163),轻、中、重度不典型增生病例术后复发率分别为7.03%(9/128)、15.38%(4/26)、55.56%(5/9),有显著性差异(P<0.01)。结论临床分期相同的患者采用三种术式疗效相同,术后复发与病变范围和肿瘤的病理分级有密切关系。

OBJECTIVE To compare the therapeutic effect of different procedures on nasal inverted papilloma. METHODS A series of 163 patients were treated by three kinds of surgical procedures： lateral rhinotomy, single endoscopic surgery, and endiscopic plus Caldwell-Luc surgery. According to the extent of diseases, the patients were staged to stage Ⅰ （79 cases）, stage Ⅱ （68cases）, stage Ⅲ （12 cases）, and stage IV （4 cases）; By the degree of the dysplasia of epithelium, they were divided into mild （128 cases）, moderate （26 cases） and severe atypical hyperplasia group （9 cases）. All the patients were followed up for 6 to 64 months after operation. RESULTS There was no obvious difference on the therapeutic effect of three kinds of surgical procedures in same stage （P〉0.05）. The total recurrence rate was 11.04 % （18/163）. The recurrence rates of the mild, moderate and severe atypical hyperplasia group were 7.03 %（9/128）, 15.38 % （4/26）, 55.56 %（5/9） respectively, there was an obvious difference among the three groups（P〈0.01）. CONCLUSION It may get the same therapeutic effect in patients with same stage by three kinds of surgical procedures. The recurrence rate is closely related to the extent of disease and the differentiation of the tumors.