3种鼻内镜手术治疗上颌窦内翻性乳头状瘤的疗效比较

A Comparison of Three Nasoendoscopic Operations for Inverted Papilloma in the Maxillary Sinus

目的探讨鼻内镜下上颌窦内翻性乳头状瘤手术方式的选择和疗效。方法2008年8月-2012年6月对88例累及上颌窦的内翻性乳头状瘤分别采取鼻内镜中鼻道入路切除肿瘤（A组，n=34）、鼻内镜下中鼻道联合尖牙窝入路切除肿瘤（B组，n=28）、鼻内镜下鼻腔外侧壁切除（C组，n=26）。结果随访18～64个月，3组患者复发率分别为35．3％（12／34）、7．1％（2／28）、3．8％（1／26），有显著性差异（χ2=13．003，P=0．002），其中C组显著低于A组（Z=-2．906，P=0．004）：B组显著低于A组（Z=-2．617，P=0．009），B、C组无显著差异（Z=-0．524，P=0．601）。结论鼻内镜下鼻腔外侧壁切除术治疗上颌窦内翻性乳头状瘤可以减少手术盲区，切除肿瘤较为彻底，较中鼻道入路有较低的复发率。

Objective To study curative effects of nasoeudoscopic operations for inverted papilloma in the maxillary sinus. Methods A retrospective analysis of 88 cases of inverted papilloma in the maxillary sinus treated under nasoendoscope from August 2008 to June 2012 was carried out. Of these cases, papilloma was rcsected by way of middle meatus antrostomy in 34 cases （ Group A） , by way of middle meatus antrostomy combined with fossa canina approach in 28 cases （Group B ） , and of medial wail of maxillary sinus in 26 cases （ Group C）. Results After 18 - 64 months of follow-up, recurrence rates of the three groups were 35.3% （12/34） , 7.1% （2/28） , and 3.8% （1/26） , respectively. There was a significant difference in recurrence rate among the three groups （χ2 = 13. 003, P = 0. 002）. Moreover, the recurrence rate was significantly lower in the Group C than that in the Group A （Z= -2.906, P =0. 004）, and significantly lower in the Group B than that in the Group A （Z = -2. 617, P =0. 009）. No significant difference was found between the Group B and C （Z = - 0. 524, P = 0. 601 ）. Conclusion According to location and extension of inverted papilloma in the maxillary sinus, appropriate adoption of operative approach can reduce the blind area, making radical resection possible and reducing the recurrence rate.