鼻内镜下治疗上颌窦内翻性乳头状瘤(IP)的预后分析

 目的   分析治疗上颌窦内翻性乳头状瘤(inverted papilloma,IP)的相关因素和获得更佳疗效的手术方法。方法    回顾性分析2003—2015年在复旦大学附属眼耳鼻喉科医院行鼻内镜下IP切除术的病例资料,手术均由同一位医师完成,分别对肿瘤分期、手术方式、影响因素及预后进行比较分析。结果    共纳入88例上颌窦乳头状瘤的患者,其中男性58例(65.9%),女性30例(34.1%),男女比例为1.9∶1。平均年龄52 岁,平均随访时间约98.6个月。主要症状依次为单侧鼻塞伴或不伴流涕56例(63.6%),鼻出血8例(9.1%),体检发现鼻腔新生物5例(5.7%),头面部胀痛5例(5.7%),嗅觉减退3例(3.4%)。88例患者中,49例(55.7%)行鼻窦开放术,39例(44.3%)采用另一种类型的手术方式,其中15例(38.5%)行上颌窦内侧壁切除术,24例(61.5%)行上颌窦前、内侧壁切除术。88例病例中有2例(2.3%)切除鼻泪管并在术中行鼻腔泪囊造口术,4例(4.5%)因涉及额窦同时行Draft Ⅱ型手术。行鼻窦开放术的患者中复发13例,术后鼻塞5例,偶有鼻出血3例,无癌变患者;行上颌窦内侧壁切除术的患者中复发2例,行上颌窦前、内侧壁切除术的患者中复发1例。39例行另一术式的患者中,术后鼻塞4例,溢泪1例,癌变2例,癌变患者术后行放化疗,其中1位患者因放疗后肉瘤死亡。癌变患者嘱其放化疗并定期随访。88例患者总复发率为18%,总恶变率为2%。结论    对不同分期的肿瘤可以用不同的内镜手术,具体术式的选择应根据患者具体的病情、肿瘤侵及的范围和术者的经验等因素综合决定。彻底切除肿瘤及其侵及的黏膜是手术成功的关键,联合术后定期随访和进行综合治疗,是治疗上颌窦IP最合理的方式。

Prognosis analysis of endoscopic surgical procedures for treatment of inverted papilloma (IP) of the maxillary sinus

Objective    To analyze the related factors in the treatment of maxillary sinus inverted papilloma and evaluate a more effective surgery method.Methods    Clinical data of 88 patients suffering from inverted papilloma (IP) which were confirmed by postoperative pathology treated with endoscopic resection in Eye & ENT Hospital,Fudan University between 2003 and 2015 were analyzed retrospectively.All operations were performed by the same doctor.We compared and analyzed tumor staging,surgery methods,influencing factors and prognosis separately.Results    Eighty-eight patients with maxillary sinus papilloma were included in the study.Among the 88 patients,58 (65.9%) were males and 30 (34.1%) were females,with a male to female ratio was 1.9∶1.The average age was 52  years old.Theaverage follow-up time was approximately 98.6 months.Postoperative follow up showed unilateral nasal obstruction with or without nasal secretion in 56 cases (63.6%),nasal bleeding in 8 cases (9.1%),5 cases of nasal neoplasms found by physical examination (5.7%),5 cases of head and face pain (5.7%),3 cases of decreased sense of smell (3.4%) and so on.Of the 88 patients,49 patients (55.7%) underwent open sinus surgery,39 patients (44.3%) underwent another new surgical method,of which 15 patients (38.5%) underwent transnasal endoscopic medial maxillectomy (TEMM),and 24 patients (61.5%) underwent transnasal endoscopic anterior and medial maxillectomy (TEAMM).Two cases (2.3%) underwent the nasolacrimal duct resection and nasal cavity dacryocystostomy,and 4 patients (4.5%) underwent Draft Ⅱ surgery for a wide range of tumor invasion.Of the 49 cases (55.7%) who underwent open sinus surgery there were 13 cases of nasal recurrence,5 cases of nasal congestion,3 cases of occasionally nose bleeding in after surgery and no case of canceration.There were 3 cases of tumor recurrence in 39 patients (44.3%) who underwent TEAMM.Of these 39 patients there were 2 patients of tumor recurrence in 15 patients (38.5%) who underwent TEMM,and 1 patient (4%) of tumor recurrence in 24 patients (61.5%) who underwent TEAMM.After surgery,there were 4 cases of nasal congestion,epiphora in 1 case,and 2 cases of malignant change which received radiotherapy and chemotherapy.One patient died of sarcoma after radiotherapy.Cancerous patient was treated with radiotherapy or chemotherapy and followed up regularly.The overall recurrence rate was 18% in 88 patients and the total malignant rate was 2%.Conclusions    Different endoscopic method should be used for different stages of tumors.The choice of specific surgical method should be determined based on the specific conditions of the patient,the extent of tumor invasion and the experience of the surgeon.Thorough resection of tumor and its invading mucosa is the key of success.Regular follow-up and comprehensive treatment after surgery should be used as a routine method for IP of the maxillary sinus.This is the most reasonable way to treat IP of maxillary sinus.