鼻内翻性乳头状瘤患者术后复发的影响因素分析

Influencing Factors of Postoperative Recurrence of Nasal Inverted Papilloma

目的:分析手术治疗鼻内翻性乳头状瘤(sinonasal inverted papilloma,SNIP)患者术后复发的临床影响因素。方法:回顾性分析2009年6月-2015年8月于复旦大学附属中山医院耳鼻咽喉-头颈外科住院手术的48例经术后病理证实为内翻性乳头状瘤患者的临床资料。其中采取鼻侧切开术治疗Ⅲ期2例,单纯鼻内镜治疗Ⅰ期患者7例、Ⅱ期患者25例、Ⅲ期患者8例,鼻内镜术+柯陆氏入路治疗Ⅲ期患者6例。分析性别、年龄、手术方案、不典型增生等因素与SNIP复发的关系。结果:48例患者主要表现为单侧鼻腔肿物、鼻塞、鼻出血、嗅觉减退等,术后复发率为22.9%(11/48)。采用单因素分析发现,鼻内翻性乳头状瘤患者术后复发与年龄、性别无关(P>0.05),与存在不典型增生及术前分期有关(P<0.05)。进一步采用二元Logistic回归分析,术前分期高及存在不典型增生是鼻内翻性乳头状瘤患者术后复发的影响因素(P<0.05)。Ⅲ期病例中联合组复发率低于单纯内镜组,差异有统计学意义(P<0.05)。结论:患者肿瘤分期越高术后复发率越高,并且伴不典型增生者术后复发率更高。肿瘤分期高患者及伴有不典型增生患者,术后应加强随访。在手术方案的选择上,Ⅰ、Ⅱ期可以选择单纯内镜下治疗,Ⅲ期病例以联合手术入路为主。

Objective:To analyse the clinical effect of surgical treatment on postoperative recurrence of the patients with nasal inverted papilloma(SNIP).Method:A retrospective analysis was made of 48 patients with inverted papilloma who underwent otolaryngology-head and neck surgery in Zhongshan Hospital Affiliated to Fudan University from June 2009 to August 2015.Among them,2 cases of stageⅢwere treated by nasal lateral incision,7 cases of stageⅠ,25 cases of stageⅡand 8 cases of stageⅢwere treated with endoscopic sinus surgery alone,and 6 cases of stageⅢwere treated by endoscopic approach.The relationship between recurrence of SNIP and gender,age,surgical procedure,atypical hyperplasia was analyzed.Result:The main manifestations of 48 patients were unilateral nasal mass,nasal congestion,nosebleed,decreased sense of smell and so on.The recurrence rate was 22.9%(11/48).Univariate analysis found that,the postoperative recurrence was not related to age and sex(P>0.05),which was related to the presence of atypical hyperplasia and pre-operative stage(P<0.05).Logistic regression analysis was used,and the pre-operative stage and the presence of atypical hyperplasia were the factors of the recurrence after the operation of the nasal inverted papilloma(P<0.05).The recurrence rate of the combined group was lower than that of the simple endoscope group in the stageⅢ,the difference was significant(P<0.05).Conclusion:The higher the staging of the tumors,the higher the recurrence rate.And the recurrence rate of the patients with atypical hyperplasia is higher.For patients with high tumor stage and atypical hyperplasia,follow-up should be enhanced after operation.In the choice of surgical options,stageⅠandⅡcan be treated by endoscopy alone.In stageⅢcases,combined surgical approach is the main approach.