鼻内镜下鼻腔鼻窦内翻性乳头状瘤切除36例疗效分析

Analysis of 36 cases Curative Effects of Nasal Inverted Papilloma Treated by Intransasl Endoscopic Approach

目的:探讨鼻内镜下鼻腔鼻窦内翻性乳头状瘤切除术的手术适应证及疗效。方法:回顾性分析2003年4月～2007年12月间在我科治疗的,有完整随访资料的36例单纯经鼻内镜(术式A)和鼻内镜、Caldwell-Luc双径路下(术式B)手术治疗的鼻腔鼻窦内翻性乳头状瘤患者的临床资料。结果:随访1～5年,术式A复发2例,均为Ⅱ期患者。复发时间分别为术后6和9个月。术式B复发3例,其中Ⅱ期1例,Ⅲ期2例。复发时间3～9个月,平均6.33个月。本组36例未见恶变和死亡。结论:单纯鼻内镜下手术治疗鼻腔鼻窦内翻性乳头状瘤是一种安全有效的微创手术,可用于Ⅰ、Ⅱ期患者的手术治疗,Ⅲ期病变可选用鼻内镜、Caldwell-Luc双径路,Ⅳ期的患者不适宜此术式。术后定期随访换药可及时发现残留和复发组织,早期实施处理措施,也是手术成功的关键。

Objective： To summary the operating indications and curative effects of nasal inverted papilloma treated by intranasal endoscopic approach. Method ： Reviewed data of 36 patients who has complete records of clinical follow up, with nasal inverted papilloma were treated by endoscopic surgery（Method A） or intranasal endoscopic and Caldwell- Luc approach（Method B） from Apr 2003 to Dec 2007. Result ：The period of followup was 1-5 years. Method A got 2 cases recurred after the surgery, both these two cases are in stage Ⅱ. Recurring times are 6 and 9 months. Method B got 3 cases recurred after the surgery, one case is in stage Ⅱ and 2 are in stage Ⅱ. Recurring times range from 3 to 9 months, 6.33 months on average. All the cases had no canceration or decease during the follow - up period. Conclusion ：The endoscopic endonasal approach is an effective treatment for an inverted papilloma, and it＇ s fit for those patients in stage Ⅰ - Ⅱ . A combination of Caldwell - Luc procedure and transnasal endoscopic sinus surgery may be needed for those patients in stage Ⅲ. And this operation is not fit for patients in stage Ⅳ. Moreover, regular consultation after operation can find out the tiny residue or recrudescence tissue in time and give the congruent treatment promptly. That is also the key point of the succeeding of the operation.