内镜下鼻内翻性乳头状瘤切除的手术进路选择与疗效

Selection of surgical approaches and efficacy of endoscopic treatment of inverted papilloma

目的探讨鼻内镜下切除鼻内翻性乳头状瘤手术进路的选择及其与疗效的关系。方法回顾性分析1999.1～2005.12经鼻内镜手术治疗鼻内翻性乳头状瘤21例的临床资料。根据KROUSE分类法分为4级:Ⅰ级2例,Ⅱ级7例,Ⅲ级11例;Ⅳ级1例。采用鼻内镜鼻内手术16例,鼻内镜联合鼻外进路10例(其中包括复发再手术5例)。结果术后随访6～69个月,有5例复发(23.8%),再次手术采用鼻内镜联合进路切除,均随访24个月未再复发。结论鼻内镜手术是治疗鼻内翻性乳头状瘤的安全有效方法,但需按分期选择术式。对于肿瘤涉及上颌窦、额窦等病变广泛的Ⅲ～Ⅳ级患者,采用联合进路可以避免手术盲区,减少肿瘤残留,降低复发率。

[Objective] To evaluate the selective criterion of endoscopic surgery and its correlative efficacy for inverted sinonasal papillomas. [Method] A retrospective analysis was performed for twenty-one patients with inverted sinonasal papilloma, who had endoscopic surgery. There were 2 cases in stage Ⅰ ; 7 cases in stage Ⅱ ; 11 cases in stage Ⅲ and 1 case in stage IV. Among these patients, 16 cases were treated by endoscopic surgery and 10 cases were treated by endoscope-assisted resection （of these 5 patients with recurrence）. They were followed-up for 6-69 months. [Results] Five cases had recurred within the period of follow-up visits （recurrent rate was 23.8%）; Patients treated by endoscope-assisted resection had on recurrance in the 24 months＇ follow-up period. [Conclusions] The endoscopic and endoscope-assisted resection of inverted papilloma are effective in treatment of inverted papilloma, but the selection of surgical approaches depending on the inverted papilloma clinical staging system. Better results for patients in stageⅢ and Ⅳ can be achieved by combining endoscope-assisted technique. They are efficacious in complete resection of the inverted papilloma.