鼻内镜下经泪前隐窝入路治疗上颌窦内翻性乳头状瘤的效果观察

Clinical Efficacy of Nasal Endoscopic Anterior Lacrimal Recess Approach in the Treatment of Maxillary Sinus Inverted Papilloma

目的观察鼻内镜下经泪前隐窝入路治疗上颌窦内翻性乳头状瘤的临床效果。方法选取2014年6月—2017年3月收治的经病理检查确诊的Krouse分级为T2、T3的上颌窦内翻性乳头状瘤30例,根据手术治疗方法的不同,分为观察组(n=14)与对照组(n=16)。观察组采用鼻内镜下经泪前隐窝入路治疗,对照组采用鼻内镜下中下鼻窦道开窗术治疗。记录手术时间、术中出血量、住院时间、术后鼻腔内创面愈合时间,采用视觉模拟评分(visual analogue score,VAS)评估术后疼痛程度,观察术后并发症及术后病情复发情况。结果两组住院时间、术后鼻腔内创面愈合时间及术后VAS比较差异无统计学意义(P>0.05);与对照组比较,观察组手术时间缩短,术中出血量减少,术后鼻泪管损伤、面部肿胀淤血的发生率及术后病情复发率下降,差异有统计学意义(P<0.05)。结论鼻内镜下经泪前隐窝入路治疗上颌窦内翻性乳头状瘤具有手术时间短、出血量少、创伤小、术后病情复发率低的优点,是治疗上颌窦内翻性乳头状瘤较好的手术方式之一。

Objective To observe the clinical efficacy of nasal endoscopic anterior lacrimal recess approach in the treatment of maxillary sinus inverted papilloma.Methods Thirty patients with pathologically confirmed Krouse grade T2 and T3 maxillary sinus inverted papilloma who were treated in our hospital from June 2014 to March 2017 were enrolled.They were divided into observation group(n=14)and control group(n=16)according to the different surgical treatment methods.The observation group underwent surgery via nasal endoscopic anterior lacrimal recess approach,and the control group underwent middle and inferior meatal antrostomy under nasal endoscope.The duration of operation,intraoperative blood loss,length of hospitalization,and nasal wound healing time were recorded.Visual analogue score(VAS)was used to assess postoperative pain level.The occurrence of postoperative complications and the recurrence after operation were observed.Results No statistically significant differences were found in length of hospitalization,nasal wound healing time and VAS after operation between the two groups(P>0.05).In the observation group,the duration of operation and intraoperative blood loss were shorter or lower,and incidence of damage of nasolacrimal duct and facial swelling and congestion after operation as well as the postoperative recurrence rate were significantly lower than those of the control group(P<0.05).Conclusion The nasal endoscopic anterior lacrimal recess approach in the treatment of maxillary sinus inverted papilloma has advantages of shorter duration of operation,less intraoperative blood loss and low postoperative recurrence rate.Therefore,it is one of preferable operation method for the treatment of the disease.