内镜下鼻腔鼻窦内翻性乳头状瘤不同术式的疗效分析

The efficacy analysis of different operative methods in sinonasal inverted papilloma

目的：分析内镜下3种不同手术方法治疗鼻腔鼻窦内翻性乳头状瘤（IP）的效果，为正确选择手术方法提供依据。方法回顾性分析2006年6月至2013年6月我院诊治的22例IP患者的临床资料。根据Krouse（2000）分级标准进行临床分级， T 1期4例，T2期6例，T3期12例；随访6个月～7年。结果全部病例均在鼻内镜下或鼻内镜联合鼻外入路下完整切除肿瘤，并发症少。总复发率为13．63％（3/22）；单纯鼻内镜手术10例，1例复发，复发率10．00％（1/10）；鼻内镜下泪前隐窝入路7例，1例复发，复发率14．29％（1/7）；鼻内镜联合Caldwell-luc入路5例，1例复发，复发率为20．00％（1/5）。结论鼻内镜下手术治疗IP是安全、有效、微创的方法，对于T 1、T2期I P可采用单纯鼻内镜手术，对于累及上颌窦的T3期病变，鼻内镜下泪前隐窝入路和鼻内镜联合Caldwell-luc入路，疗效相似，但泪前隐窝入路创伤更小、并发症更少。

Purpose The goal of this study was to assess the efficacy of endoscopic surgery in the treatment of sinonasal inverted papilloma （IP）.Methods We retrospectively analyzed clinical data of 22 IP cases from one treatment group.According to Krouse （2000） standards,we divided all cases into three groups T1 ,T2 and T3 stages which have 4,6 and 12 cases respectively.All cases were follow-up from 6 months to 7 years.Results All patients were operated by endoscopic or combined nasal endoscopic approach to completely remove the tumor with fewer complications.The total recurrence rate is 13.63%（3/22）.Seven cases were performed by endoscopic surgery alone.1 case was recrudescent and the recurrence rate is 10.00%（1/10）;7 cases were treated by tears crypt before endoscopic approach with 1 case re-currence,and the recurrence is 14.29% （1/7）;5 cases were operated by endoscopic approach combined Caldwell-luc with 1 recrudescent case,and the recurrence rate is 20.0%（1/5）.Conclusion Endoscopic surgery is a safe,effective and minimally invasive approach to treat IP.Endoscopic surgery alone can be used in T1 IP.For T3 IP involving the maxillary,crypts tears before endoscopic approach and endoscopic approach combined Caldwell-luc have similar treatment efficiency.But the surgery via crypts tears before endoscopic approach has less inva-sive with fewer complications.