鼻内镜联合低温等离子刀手术治疗鼻内翻性乳头状瘤的疗效观察

目的:探讨经鼻内镜下鼻腔鼻窦乳头状瘤切除的手术方式和经验，观察治疗效果。方法:对本院2010年2月至2015年2月收治的鼻腔鼻窦乳头状瘤48例患者的临床资料进行回顾性分析，患者均在鼻内镜下行低温等离子刀切除治疗或联合柯－陆式上颌窦入路或联合泪前隐窝入路切除肿瘤，其中鼻腔肿瘤29例，鼻窦肿瘤19例，对其临床疗效行追踪随访24~36个月，对手术方法和技巧进行总结分析。结果:本组48例患者均手术成功切除病变组织，4例患者在随访期间复发，复发率为8.33％，与国内报道鼻内镜鼻内翻乳头状瘤22%术后复发率相比较，复发率明显较低(P<0.05)。本组3例复发病例通过术后鼻内镜复查时发现，给予局部切除，经低温等离子刀局部电凝后治愈，1例经二次手术彻底清除病灶后治愈。无１例术中或术后严重并发症发生，达到了良好的临床疗效。结论:鼻内镜联合低温等离子刀切除鼻腔鼻窦乳头状瘤可取得较好的临床疗效，根据病变范围及分期选择合适的手术方式及术中准确判断切除瘤体的根蒂部对保证手术的成功具有重要意义，术后鼻内镜密切随访，联合低温等离子刀处理，对达到治愈的目的及降低二次手术概率具有重要的意义。

Observation of the curative effect of the nasal inverted papilloma treated by nasal endoscopic and low-temperature plasma

Objective:To discuss surgical methods and experience of the excision of the intranasal and paranasal papilloma via the nasal endoscope and observe the curative effect.Methods:Retrospective analysis was conducted to clinical data of 48 patients suffering from the intranasal and paranasal papilloma treated in the hospital from February 2010 to February 2015. All the patients had tumor resection by low-temperature plasma，Caldwell-Luc maxillary sinus approach or lacrimal recess approach under the assistance of nasal endoscope. Among them，there are 29 patients with the nasal tumor and 19 patients with nasal sinuses tumor. The 24-to 36-month follow-up for clinical effects was conducted，to summarize and analyze the surgical methods and skills.Results:48 patients of this group had the diseased tissue removed successfully via surgery.4 cases of them relapsed during follow-up，with a rate of 8.33%. Compared to 22% postoperative relapse rate in the nasal inverted papilloma via the nasal endoscope reported in China，P<0.05. 3 patients of the 4 cases were found with relapse during the nasal endoscopic reexamination and cured after local resection and local electrocoagulation via the plasma knife and 1 patient of the 4 cases was cured by thorough debridement in a second operation. None of them suffered from serious intraoperative or postoperative complications and good clinical effects were reached.Conclusion:Preferable clinical effects can be obtained for the intranasal and paranasal papilloma by resection of the low-temperature plasma knife with the aid of the nasal endoscope. It is of great significance to ensure successful operation by selecting appropriate surgery based on extent and staging of the disease and accurate judgment of the root and base of the tumor for resection during the surgery, together with postoperative close follow-up and low-temperature plasma treatment, so as to achieve the aim of curing and lower the probability of second surgery.