鼻内窥镜加柯-陆氏手术治疗鼻内翻性乳头状瘤

Endoscopic and Caldwell-Luc surgery in treating nasal inverted papilloma

目的 :探讨彻底治疗鼻内翻性乳头状瘤 ,降低术后复发率的手术方法。方法 :治疗临床及病理确诊为内翻性乳头状瘤 31例 ,其中 10例有 1～ 2次前期经鼻或经上颌窦前壁 (Caldwell -LUC术式 )的手术史。经前鼻孔镜 ,鼻内窥镜检查和CT检查 ,见肿瘤侵及鼻腔、中鼻甲、中鼻道、上颌窦、筛窦 2 6例 ;侵及鼻腔、筛窦、上颌窦、蝶窦 5例。 31例在鼻窦镜下行鼻腔、中鼻甲、筛窦、蝶窦肿瘤切除术 ,用柯 -陆氏术式清理上颌窦肿瘤及残余鼻腔外侧壁肿瘤组织。随访 1年至 1年 6个月。结果 :31例中 2例复发 ,复发率 6 .4 3% ,复发2例 ,经再次手术 ,随访 1年无复发。结论 :对于鼻腔鼻窦内翻性乳头状瘤侵及鼻腔鼻窦 ,尤其是上颌窦同时受侵者 ,应用鼻内窥镜加柯 -陆氏术式辅以电刀或微波处理创面 ,鸦蛋子油纱条填塞术腔 。

Objective: To study how to treat nasal inverted papilloma and to decrease the postoperative recurrence rate. Method: 31 cases who were diagnosed as nasal inverted papilloma were examined by endoscope and CT, and were found the tumor invaded the nasal cavity, middle nasal concha, middle meatus, maxillary sinus and ethmoidal sinus in 26 cases and the nasal cavity, ethmoidal sinus, maxillary sinus and sphenoidal sinus in 5 cases. All of them were performed tumor extraction under endoscopy and cleared the maxillary sinus tumor and the left nasal cavity lateral wall tumor tissue by Caldwell-Luc surgery. Result: Followed up from 1 to 1.5 years, 2 (6.43%) cases relapsed . After reoperation of 1 year, none relapsed. Conclusion: Nasal inverted papilloma invaded paranasal sinus and maxillary sinus should be treated by transnasal and Caldwell-Luc endoscopic surgery combined with shaver system and the iradiation of laser or microwave.