鼻腔-鼻窦少见非上皮性良性肿瘤临床分析

Non-epithelial benign tumors rarely developed in nose and paranasal sinus(with a report of 16 cases)

目的总结鼻腔-鼻窦少见非上皮性肿瘤的诊疗经验,提高其诊疗水平。方法回顾性研究16例鼻腔-鼻窦少见非上皮性良性肿瘤患者,分析其临床表现特征、治疗模式及随访结果,总结经验教训。结果16例患者均采用手术治疗,其中4例行鼻侧切开术,6例上颌窦柯-陆手术,6例行鼻内镜手术;2例嗜酸性肉芽肿患者术后补行小剂量放疗。12例随访观察4年,均无复发。2例骨化纤维瘤和2例砂砾样脑膜瘤患者出现复发,经再次手术而痊愈,继续随访2年无复发。结论鼻腔-鼻窦非上皮性良性肿瘤的早期临床表现无特异性,容易漏诊、误诊;综合分析影像学、组织病理学资料及免疫组织化学方法检测结果,有助于正确诊断。手术中应将病变组织切除干净;如果病变复发,可以再次手术。

Objective To sum up clinical experience with the diagnosis and treatment for rarely developed non-epithelial benign tumors in nose and paranasal sinus to improve the diagnostic and therapeutic levels for such a kind of lesions based on a clinical trial. Methods A retrospective study was carried out among 16 cases with rarely developed non-epithelial benign tumors in nose and paranasal sinus, with a careful analysis on their clinical data including characteristics in symptoms, therapeutic modes and the outcome following the therapy, as evaluated by following up results to make a summary about the experience and lesions with such lesions. Results All these 16 cases were treated by surgical procedures, with 4 undergone lateral rhinotomy, 6 received Cold-Luc operation and 6 operated on by endoscopic surgery. Moreover, 2 cases with eosinophilic granuloma out of these patients were additionally given a course of radiotherapy at low dosage following lateral rhinotomy. A following up procedure was carried out among these cases after the surgical therapy, with no reocurring lesions found among 12 of them during the follow up period lasted for 4 years. For the other 2 cases with ossifying fibroma and 2 cases with meningioma, their lesions were cured by surgery once more, with their lesions reoccurred no more as evaluated during the another course of following up lasted for 2 years. Conclusions There may be no specific Clinical manifestations in the early stage of rarely seen non-epithelial benign tumors in nose and paranasal sinus. Therefore, missed diagnosis and/or misdiagnosis may occur for this kind of conditions sometimes. To make a correct diagnosis in time among these cases, aggregated analysis must be carefully carried out on all possible image data and pathohistological findings, including the results from special immunohistochemical assays. For these lesions, appropriate radical operation is necessary to avoid them from reoccurring. Once reoccurred, re-operation should be performed to cure them.