鼻内镜下鼻腔内翻性乳头状瘤电凝电刀手术治疗后初步观察

Endoscopic surgery using the electro-coagulation and electrotomy for nasal inverted papilloma

目的：探讨鼻内窥镜下电凝电刀手术治疗鼻腔内翻性乳头状瘤的方法和初步疗效。方法：对2008年11月至2010年12月诊治的20例鼻腔内翻性乳头状瘤的临床资料进行回顾性分析,全部患者均接受鼻内窥镜下鼻腔乳头状瘤切除术的手术方案。按Krouse分级,其中1级局限于鼻中隔患者3例和2级病变位于鼻腔上颌窦口周围患者10例,病变侵及筛窦5例,均全程采用电凝电刀完成手术治疗,属3级病变的既往手术复发者2例,病变累及全组鼻窦伴轻度骨质破环2例,采用电刀电凝结合电动吸切器完成手术治疗,手术过程均在全麻鼻内窥镜下进行。结果：除2例复发的属3级病变的鼻腔乳头状瘤病例,均完成肿瘤根治切除,术中出血较少,除2例复发性内翻性乳头状瘤患者出血约150ml外,其余18例原发性患者出血量为10-50ml,中位数出血量35ml。手术时间短,为20-60min,术中术野清晰,无颅-额-眶手术并发症,术后1天抽取纱条,3天后出院,3个月后复查见术腔完全上皮化。随访3-6个月,中位随访时间4个月,20例鼻腔乳头状瘤病例术前鼻塞,血性脓涕,头痛等症状均缓解,无复发病例。结论：电凝电刀手术治疗鼻腔内翻性乳头状瘤具有手术损伤小,手术时间短,手术视野清晰,对病变的基底及安全边缘切除彻底,不易造成瘤组织的血行播散,术中及术后出血少,围手术期不良反应轻,术后不易复发等优点,对于1级和2级病变可做到肿瘤完整切除,是一种较好的微创治疗鼻腔内翻性乳头状瘤的方法。

Objective：To discuss the effect of endoscopic surgery using the electro-coagulation and electrotomy for nasal inverted papilloma.Methods： In this retrospective study,clinical data of 20 patients underwent endoscopic surgery were analyzed since Novermber 2008 to December 2010.Tumor stage according to Krouse was T13 cases,T215 cases,T32 cases.3 T1 cases localized in the nasal septum and 10 cases T2 patients localized around the maxillary sinus ostium and 5 T2 cases invading to the ethmoid sinus was completely excised using electro-coagulation and electrotomy,2 T3 cases lesion was excised using microdebrider combined with electro-coagulation and electrotomy.Results： In 18 patients blood loss was about 10-50 ml with median 35ml,in 2 recurrent nasal papilloma patients blood loss was 150 ml.The operative time was shorter than average from 20-60 min,the operative visual field was clearer than the traditional methods.There were no cranial-frontal-orbital complications.All patients extracted the nasal stuffing 1 day later and dehospitalized 3 days later and were followed-up for 3-6 months,median 4 months,all the patients preoperative symptoms such as nasal obstruction,bloody suppurative secretion,headache were all eased,without recurrent case.Conclusion： Surgical treatment of nasal inverted papilloma using electro-coagulation and electrotomy had following advantage：lesser operative injury,less operative time,clearer operative visual field,achieve the radical resection of the papilloma.It is not liable for the tumor dissemination,the blood loss is less than average during and after the operation,the perioperative period side effect is mild and not liable to recurrence,the Ⅰgrade and Ⅱgrade tumor can be radically resected.It is a kind of good mild-injury treating method for the nasal inverted papilloma.