泪道置管联合鼻内镜下上颌窦内壁扩大切除术治疗鼻内翻性乳头状瘤效果观察

Lacrimal tube implantation plus extended transnasal endoscopic resection of the inner wall of maxillary sinus for nasal inverted papilloma

目的探讨和完善鼻内镜下彻底切除鼻内翻性乳头状瘤、降低术后复发率的手术方法及适应症。方法总结1999年1月-2008年12月确诊为鼻内翻性乳头状瘤的患者，按Krouse分期均为Ⅱ～Ⅲ级病例，治疗组39例，其中7例（17．9％）既往有1～2次鼻部手术史。术中先泪道置管，并应用动力系统切除瘤体，切除上颌窦内壁大部，30°镜下将肿瘤于肿瘤基底部周围骨膜下剥离，局部骨骼化，基底部残余软组织用电刀将其烧灼以防止复发。对照组21例，采用Caldwell—Luc术式或鼻侧切开术治疗。术后每周复查至术腔上皮化，此后长期随访。结果所有患者均在鼻内镜下随访，治疗组39例患者中，1例于术后4月复查时发现后组筛窦内复发，予咬除肿物后以电刀烧灼后随访至今未见复发（随访已超过3年）。其余38例经随访1—9年，未见复发，治愈率97．4％。对照组21例中5例复发两组复发率比较差异有显著性（p〈0．05）。结论在正确选择适应证的前提下，泪道置管联合鼻内镜下上颌窦内壁扩大切除术治疗鼻内翻性乳头状瘤具有微创、避免面部瘢痕、手术时间短、出血少、便于术后复查、手术在同一术野进行等优点，有利于肿瘤的彻底切除。

Objective To explore endoscopic resection of nasal inverted papilloma （NIP） and the surgical procedure for reducing postoperative recurrence and its indications. Methods 39 patients who had been diagnosed as stage Ⅱ -Ⅲ NIP during January 1996 to December 2008 were assigned to the study group, 7 of whom （17.9%） had a history of nasal surgery. After a tube was implanted into the lacrimal duct, the tumor was removed using the Xps3000 and most of the inner wall of maxillary sinus was resected. The bony attachment of the tumor and the neighboring tissues were resected and the residual soft tissues were cauterized to prevent relapse. 21 patients received Caldwell-Luc prccedure or paranasal incision in the control group. Restults All the patients were followed up with transnasal endoscopy. One of 39 patients in the study developed recurrence in the posterior ethmoid sinus. But after the small mass of recurrence was removed and cauterized, recurrence disappeared more than 3 year. No relapse was found in the rest 38 patients during a follow-up of 1 to 9 years, with a curative rate of 97.4%. 5 of 21 patients occurred in the control group. Conclusions Under the condition of proper selection of candidates, lacrimal tube implantation plus extended transnasal endoscopic resection of the inner wall of maxillary sinus for nasal inverted papilloma is less invasive, preventing the formation of facial scars, and it has shorter surgical duration and less bleeding.