鼻腔-鼻窦内翻性乳头状瘤复发与恶变的治疗

Management of sinonasal inverting papilloma with recurrence and malignant transformation

目的 探讨鼻腔 鼻窦内翻性乳头状瘤复发与恶变的临床特点与治疗方法。方法 回顾性分析 1990～ 2 0 0 0年我院收治的鼻腔 鼻窦内翻性乳头状瘤复发和恶变患者的临床资料。结果2 2例肿瘤复发患者既往均有鼻腔 鼻窦手术史 ,其中复发 1次者 13例 ,复发 2次者 7例 ,复发 3次者 1例 ,复发 4次者 1例 ,复发时间从 3个月～ 11年。 2 2例中 ,经鼻腔入路 ,经上颌窦根治径路 ,经鼻侧切开径路的复发率分别为 73 3% ,4 2 9%和 33 3% ,10例采用了内镜或内镜辅助手术 ,经随访 1～ 5年 ,未见肿瘤再次复发。 8例肿瘤恶变患者 ,4例接受了鼻侧切开肿瘤切除术 ,1例柯 陆手术 ,手术后均给予放射治疗 (40～ 70Gy) ,这 5例经随访 2～ 6年未见肿瘤复发 ,另外 3例 ,1例失随访 ,2例死亡。结论 积极、彻底的内镜下手术 (包括内镜 +外部切口的联合入路 )是治疗内翻性乳头状瘤 (包括复发肿瘤 )的首选方法 ,对于肿瘤恶变患者应采取广泛手术切除加手术后放射治疗 。

Objective To investigate the clinical characteristics and optimum management of sinonasal inverting papilloma with recurrence and malignant transformation Methods Retrospective analysis of inverting papilloma with recurrence and malignant transformation treated from 1990 to 2000 in PLA general hospital Results All the 22 patients with recurrence had the history of sininasal surgery Among them,13 patients recurred once,7 recurred 2 times,1 recurred 3 times and 1 recurred 4 times The recurrence time was from 3 months to 11 years Among the 22 patients with recurrence,the recurrence ratio of different surgery was different,for example intranasal approach was 100%,maxillectomy 60%and lateral rhinotomy 42%,10 patients were operated with endoscope or endoscopie assisted surgery with no recurrence after 1 5 year′s follow up Among 8 patients with malignant transformation,4 received lateral rhinotomy,1 Caldwell Luc operation, all of them were given radiation therapy after operation (40 70 Gy) and no recurrence were found during 2 to 6 years follow up Of the other 3 patients, 2 died and 1 lost follow up Conclusion The endoscopic surgery(including the method of endoscopy combined with extranasal incision) is the optimum management for inverting papilloma in nasal cavity and paranasal sinuses To the patients with malignant tumors,extensive excision and post operative radiotherapy should be considered,but the prognosis is not satisfactory