鼻内镜下不同入路手术治疗上颌窦内翻性乳头状瘤的疗效

Therapeutic efficacy of different endoscopic surgery approaches for inverted papilloma of maxillary sinus

目的探讨鼻内镜下泪前隐窝入路(PLRA)与柯陆入路手术治疗上颌窦内翻性乳头状瘤(IP)的疗效。方法回顾性分析2019年2月—2022年7月重庆市大足区人民医院收治的73例上颌窦IP患者的临床资料,根据手术入路不同分为PLRA组(36例)和柯陆组(37例)。PLRA组患者采用鼻内镜下中鼻道联合PLRA入路术式,柯陆组患者采用鼻内镜下中鼻道联合柯陆入路术式。比较2组患者的围手术期指标(手术时间、术中出血量、住院时间)、术后并发症发生情况、医师术野满意度、手术前后炎症氧化应激指标[肾上腺素、皮质醇(Cor)、白细胞介素5(IL-5)、转化生长因子-β1(TGF-β1)]变化情况,以及术后随访6个月的复发情况。结果PLRA组患者手术时间、鼻腔恢复通气时间、住院时间均短于柯陆组,术中出血量小于对照组,差异均有统计学意义(P<0.05)。PLRA组医师术野非常满意率为72.22%(26/36),高于柯陆组的45.95%(17/37),差异有统计学意义(χ^(2)=5.204,P=0.023)。PLRA组患者术后并发症发生率为2.78%(1/36),低于柯陆组的21.62%(8/37),差异有统计学意义(χ^(2)=4.378,P=0.036)。2组患者术后1 d血清肾上腺素、Cor、IL-5、TGF-β1水平均高于术前,但PLRA组均低于柯陆组,差异均有统计学意义(P<0.05)。PLRA组患者术后6个月复发率为5.56%(2/36),柯陆组为13.51%(5/37),差异无统计学意义(χ^(2)=0.573,P=0.449)。结论鼻内镜下PLRA术式与柯陆入路术式治疗上颌窦IP效果均良好,但采用PLRA术式的患者围手术期指标优于采用柯陆入路的患者,并发症发生风险更低,临床上可根据患者实际情况选择恰当术式以促进患者术后恢复。

Objective This paper aims to investigate the effect of the endoscopic prelacrimal recess approach(PLRA)and Caldwell-Luc approach in the treatment of inverted papilloma(IP)of the maxillary sinus.Methods The clinical data of 73 patients with maxillary sinus IP admitted to the People's Hospital of Dazu from February 2019 to July 2022 were retrospectively analyzed and assigned to the PLRA group(n=36)and Caldwell-Luc group(n=37)following different surgical approaches.Patients in the PLRA group received the middle meatus combined with the PLRA approach under the nasal endoscope,and patients in the Caldwell-Luc group the middle meatus combined with the Caldwell-Luc approach under the nasal endoscope.Perioperative parameters(time of operation,intraoperative blood loss,length of hospital stay),postoperative complications,physician field satisfaction,changes in inflammatory stress parameters[epinephrine,cortisol(Cor)interleukin 5(L-5)transforming growth factor-β1(TGF-β1)]before and after surgery,and recurrence after 6 months of postoperative follow-up were compared between the two groups.Results The time of operation,nasal ventilation recovery time,and length of hospital stay of patients in the PLRA group were significantly shorter than those in the Caldwell-Luc group,and the intraoperative blood loss was significantly less than that in the control group(P<0.05).The highly satisfactory rate of the surgical field in the PLRA group was 72.22%(26/36),which was significantly higher than that in the Caldwell-Luc group[45.95%(17/37);χ^(2)=5.204,P=0.023].The incidence of postoperative complications in the PLRA group was significantly lower than that in the Caldwell-Luc group[2.78%(1/36)vs.21.62%(8/37);χ^(2)=4.378,P=0.036].Serum epinephrine,Cor,IL-5,and TGF-β1 levels were significantly increased 1 d after surgery in both groups,but were significantly lower in the PLRA group than in the Caldwell-Luc group(P<0.05).The recurrence rate at 6 months after surgery was 5.56% in the PLRA group and 13.51%in the Caldwell-Luc group,and the difference was not statistically significant(χ^(2)=0.573,P=0.449).Conclusion Nasal endoscopy combined with PLRA and Caldwell-Luc surgical approach is effective in the treatment of maxillary sinus IP,but the perioperative indicators of patients with PLRA are superior to those of patients with the Caldwell-Luc surgical approach,with lower complication risks.The appropriate surgical method can be selected following the actual situation of patients in clinical practice to promote postoperative recovery.