经鼻内镜切除鼻窦良性肿瘤疗效的比较

Retrospective comparative analysis of intranasal endoscopic resection of sinonasal tumors

目的 探讨经鼻内镜手术切除鼻腔鼻窦良性肿瘤的疗效和适应证。方法 对经鼻内镜手术治疗的 12例鼻腔鼻窦良性肿瘤和同期治疗的 12例内翻性乳头状瘤进行回顾性比较研究。结果 5例血管瘤 ,1例神经纤维瘤 ,1例纤维瘤和 1例良性瘤样纤维组织增生均完全切除。 4例骨化纤维瘤 ,2例 1次手术完全切除 ,术后 3年无复发 ;1例 2次手术后全部切除 ,随访 10个月无复发 ;1例大部分切除 ,随访 3年未见肿瘤生长。 12例内翻性乳头状瘤中 2例恶变 ,8例 1次手术完全切除 ,2例术后发现残灶 ,YAG激光处理 ,2例分别于术后 3个月和 18个月发现残留和复发均再手术治愈。所有病例除 1例失访外 ,平均随访 36个月 ,均未再复发。结论 内镜手术视野清晰 ,损伤小 ,面部无瘢痕。该术式对于部分良性肿瘤的治疗效果与标准外进路相近。

Objective To investigate the effectiveness and indication of intranasal endoscopic resection of sinonasal benign tumors. Methods A retrospective comparative study was made of intranasal endoscopy among twelve patients with benign tumors and twelve patients with inverting papilloma of the nose and paranasal sinuses between October 1996 and June 2001. A follow up was made for ten months to five years. Results Of the twelve cases of benign tumors, five cases of hemangioma including one case of nasopharyngeal angiofibroma, one case of fibroma and one case of neurofibroma as well as one case of benign fibromatosis of nasal ethmoid sinus were completely excised without any evidence of recurrence so far. Of the four patients with ossifying fibromas, two cases with ethmoid sinus invasion underwent successful total removal without any recurrence three years after operation, one case was completely ablated after second procedure and another case had her tumor subtotally resected with symptom remission. Of the twelve cases of inverting papilloma among which two patients had cancerated, eight achieved complete resection at first attempt, and the remaining four cases having either persistence or recurrence of tumor also got cured via endoscopic YAG laser or revision procedure. All these 12 patients except one were followed up for two to five years without any recurrence. Conclusion With excellent visualization, a less operative invasiveness and no scar on face the endoscopic approach appears to be the method of choice for the treatment of some benign tumors including inverting papilloma of nose and paranasal sinuses.