鼻内镜下鼻腔鼻窦内翻性乳头状瘤切除的手术进路选择与疗效分析

Endoscope to treat of inverted papilloma of the nasal cavity and parasinus: selection of surgical approaches and its efficacy

目的探讨鼻内镜下切除鼻腔鼻窦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1996年8月～2008年2月经鼻内镜手术治疗的鼻腔鼻窦内翻性乳头状瘤91例患者的临床资料。按照Krouse分类法分为4级:Ⅰ级18例,Ⅱ级45例,Ⅲ级25例,Ⅳ级3例。其中采用单纯鼻内镜手术组(A组)Ⅰ级18例、Ⅱ级33例、Ⅲ级13例;鼻内镜联合改良柯-陆术式手术组(B组)Ⅱ级12例、Ⅲ级12例;鼻内镜联合鼻外进路手术组(C组)Ⅳ级3例。结果术后随访18～90个月,平均37个月,有15.4%(14/91)复发,其中A组Ⅰ级5.6%(1/18)、Ⅱ级6.1%(2/33)、Ⅲ级53.8%(7/13);B组Ⅱ级16.7%(2/12),Ⅲ级8.3%(1/12);C组Ⅳ级33.3%(1/3),统计结果提示Ⅱ级病例,A组和B组复发率无差异,而Ⅲ级病例,A组和B组复发率有差异,A组复发率高。复发病例行再次手术,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,大部分可以通过单纯鼻内镜径路术式完成,但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 selection criterion of endoscopic surgical approaches and its correlative efficacy for inverted papillomas of the nasal cavity and parasinus.【Method】A retrospective analysis was performed in seventy-nine patients with inverted sinonasal papilloma who were operated by endoscopic surgery.There were 18 cases in stage Ⅰ;45 cases in stage Ⅱ;25 cases in stage Ⅲ and 3 cases in stage Ⅳ.Among these patients,64cases were treated by endoscopic surgery and 27 cases were treated by endoscope-assisted resection.The period of follow-up was 18 ~ 90 months.【Results】Fourteen cases had recurred within the period of follow-up（recurrent rate was 15.4%）,and these patients were treated by endoscope-assisted resection and no one had recurred follow-up 24 months.【Conclusions】 The endoscopic and endoscope-assisted resection of inverted papilloma are effective techniques for treatment of inverted papilloma,but the selection of the surgical approaches