鼻内镜手术联合低温等离子射频消融术治疗鼻腔鼻窦内翻性乳头状瘤的疗效研究

Curative effect of nasal endoscopic surgery combined with low-temperature plasma radiofrequency ablation in the treatment of inverted papilloma of the nasal cavity and paranasal sinuse

目的探讨鼻内镜手术联合低温等离子射频消融术治疗鼻腔鼻窦内翻性乳头状瘤(SINP)的疗效及对术后复发的影响。方法选取2017年9月至2019年9月该院收治的SINP患者90例作为研究对象,根据患者入院编号分组,奇数纳入对照组,偶数纳入研究组,每组45例。对照组采用鼻内镜手术治疗,研究组联合鼻内镜手术与低温等离子射频消融术治疗。比较两组患者临床疗效,记录复发情况,并进一步分析可能影响复发的相关因素。结果研究组患者总有效率明显高于对照组,术中出血量、复发率均明显低于对照组,手术及住院时间均明显短于对照组,差异均有统计学意义(P<0.05);复发组患者性别、年龄、病程、病灶部位与未复发组比较,差异均无统计学意义(P>0.05);Krouse分级、核分裂象数、不典型增生、手术方式与未复发组比较,差异均有统计学意义(P<0.05)。明显不典型增生、鼻内镜手术方式、Krouse分级Ⅲ及Ⅳ级、核分裂象数大于或等于10个是影响SINP患者术后复发的危险因素,差异均有统计学意义(P<0.05)。结论鼻内镜手术联合低温等离子射频消融术治疗SINP疗效较佳,能有效减少术中出血量,缩短手术及住院时间,降低术后复发率,值得推广应用,且不典型增生、手术方式、Krouse分级、核分裂象数等因素均会对术后复发产生影响,提示临床医师应针对以上因素对患者进行干预,改善其预后。

Objective To investigate the curative effect of nasal endoscopic surgery combined with low-temperature plasma radiofrequency ablation in the treatment of inverted papilloma of the nasal cavity and paranasal sinuse(SINP)and the influence on postoperative recurrence.Methods Ninety patients with SINP who were admitted and treated in the hospital between September 2017 and September 2019 were selected as the research subjects.They were grouped according to the admission number,and patients with odd numbers were included in the control group(n=45),and those with even numbers were included in the study group(n=45).The control group was treated with nasal endoscopic surgery,and the study group was treated with nasal endoscopic surgery combined with low-temperature plasma radiofrequency ablation.The curative effect was compared between the two groups,and recurrence was recorded.Relevant factors that might affect recurrence were analyzed.Results The response rate of the study group(97.78%)was significantly higher than that of the control group(82.22%,P<0.05).The intraoperative blood loss of the study group was significantly less than that of the control group,and the operation time and hospital stay were significantly shorter than those of the control group(P<0.05).The recurrence rate in the study group(6.67%)was significantly lower than that in the control group(31.11%,P<0.05).There was no significant difference in gender,age,course of disease or lesion location between the recurrence group and the non-recurrence group(P>0.05).However,differences in Krouse classification,mitosis,atypical hyperplasia and surgical methods were significant(P<0.05).Logistic regression analysis found that obvious atypical hyperplasia,nasal endoscopic surgery,Krouse gradeⅢandⅣand mitosis≥10 were risk factors for recurrence after surgery of SINP(P<0.05).Conclusion Nasal endoscopic surgery combined with low-temperature plasma radiofrequency ablation is effective in the treatment of SINP,which can effectively reduce intraoperative blood loss,shorten operation time and hospital stay,and reduce postoperative recurrence rate.Besides,analysis found that factors such as atypical hyperplasia,surgical methods,Krouse classification and mitosis will affect postoperative recurrence,suggesting that clinical intervention should be carried out according to the above factors to improve the prognosis.