不同术式治疗鼻内翻性乳头状瘤疗效分析

Therapeutic effect of different operation procedures on sinonasal inverted papilloma

目的比较鼻内镜手术与开放式手术治疗鼻内翻性乳头状瘤的疗效,分析两种手术方式各自的优势与不足。方法回顾性分析1992年1月～2007年12月接受手术的171例鼻内翻性乳头状瘤病例。采用Krouse分期体系将所有病例分组,Ⅰ期29例,开放式手术12例,鼻内镜手术17例;Ⅱ期85例,开放式手术46例,鼻内镜手术39例;Ⅲ期49例,开放式手术24例,鼻内镜手术25例;IV期8例,均为开放式手术。分别比较各期组内及总体开放式手术与鼻内镜手术的术后复发率。结果各期组开放式手术与鼻内镜手术术后复发率的比较如下:Ⅰ期病变,8.3%(1/12) vs 11.8%(2/17);Ⅱ期病变,17.4%(8/46) vs 10.3%(4/39);Ⅲ期病变,12.5%(3/24) vs 12.0%(3/25);Ⅳ期病变均为开放式手术,复发率为25%(2/8)。总体术后复发率:鼻内镜手术为11.1%(9/81),开放式手术15.6%(14/90)。各期病变开放式手术和鼻内镜手术后复发率比较,均无统计学差异。结论鼻内镜手术治疗鼻内翻性乳头状瘤的效果不差于或略好于开放式手术。对Ⅲ期病变患者各地应根据当地的硬件条件及技术水平选择合适的手术术式。

OBJECTIVE To compare the effectiveness of endoscopic resection and traditional open procedure for sinonasal inverted papilloma（IP） and to evaluate the advantages and limitations of both approaches.METHODS We retrospectively reviewed the medical records of 171 patients with IP treated at Anhui Provincial Hospital from Jan.1992 to Dec.2007.According to the Krouse staging system for IP,patients were categorized into four groups：Stage I 29 cases,12 of them were treated with external approach,17 with endoscopic approach;StageⅡ 85cases,46 with external approach,39 with endoscopic approach;Stage Ⅲ 49cases,24 with external approach,25 with endoscopic approach;StageⅣ 8 cases,all with external approach.Recurrence rate of endoscopic approach in each stage group was compared with that of external approach in the same group,and the overall recurrence rates of both approaches were compared as well.RESULTS The recurrence rates were known as follow：Stage Ⅰgroup：8.3%（1/12） for external approach,11.8%（2/17） for endoscopic approach;Stage II：17.4%（8/46） for external approach,10.3%（4/39） for endoscopic approach;Stage Ⅲ：12.5%（3/24） for external approach,12.0%（3/25） for endoscopic approach;Stage IV：25%（2/8）.And the overall recurrence rates were 15.6%（14/90） for external approach and 11.1%（9/81） for endoscopic approach.There was no statistically significant difference for recurrence rate between endoscopic and external approach,no matter within each stage group or of overall pair.CONCLUSION The effectiveness of endoscopic resection of IP are comparable to external approach.As for stageⅢ patients,surgical approach should be choose according to the skill and experience of the doctors and the equipments available.