鼻内翻性乳头状瘤手术术式的选择与疗效

Selection of surgical approaches and their effects for nasal inverted papilloma

目的探讨鼻内镜术与传统术式相结合治疗鼻内翻性乳头状瘤的疗效,并对不同术式进行探讨。方法回顾性分析我科2002年1月～2009年1月有完整随访资料并接受鼻内镜手术治疗的54例鼻内翻性乳头状瘤患者的临床资料进行回顾性分析。其中采用单纯鼻内镜手术44例,采用鼻内镜联合改良柯-陆术式9例,采用鼻内镜联合鼻侧切开1例,并对所有患者术后进行随访。结果随访6个月至6年,3例术后复发,其余51例在随访期内均未见复发。结论鼻内镜下手术是一种安全有效的微创手术,可用于Ⅰ、Ⅲ级鼻内翻性乳头状瘤外科治疗,Ⅱ级病变可选择联合改良柯-陆术式,肿瘤已侵犯至鼻外的Ⅳ级病变需联合鼻侧切开径路去除病灶。彻底切除肿瘤、术后定期随访是治疗成功的关键。

Objective To evaluate the effect of endoscopic surgery plus traditional procedures in the management of nasal inverted papilloma（IP） and to discuss the selection of surgical approaches for this tumor.Methods The clinical data of 54 patients suffering from nasal IP treated with endoscopic surgery from Jan 2002 to Jan 2008 was analyzed retrospectively.All the 54 cases were divided into four groups according to Han＇s criterion.All of them,44 cases were treated by endoscopic surgery only,9 cases by endoscopic plus Caldwell-Luc technique,and 1 case by endoscopic plus lateral rhinotomy approach.Results All patients were followed up from six months to six years postoperatively.Of them,the tumor was totally removed in all and 51 cases had no recurrence.As for the other 3 cases with local recurrence,revise operation was performed with good outcome.Conclusion Endoscopic surgery offers a safe and effective method for nasal inverted papilloma with minimally invasion.This procedure is suitable for the treatment of nasal IP of Han’s stageⅠand Ⅲ.Endoscopic plus Caldwell-Luc technique is recommended for the patients of stage Ⅱ.However,endoscopic plus lateral rhinotomy approach should be considered for treatment of stage Ⅳ.Thorough removal of the tumor and regular follow-up are the key points for success.