低温等离子消融在鼻内翻性乳头状瘤手术中的应用体会

目的通过低温等离子射频消融术与电动切割器术在治疗鼻内翻性乳头状瘤疾病中的对比分析,评估鼻内镜下低温等离子射频消融治疗鼻内翻性乳头状瘤的可行性并总结经验。方法将2017年1月~2019年8月本院收治的68例鼻内翻性乳头状瘤患者随机分为治疗组和对照组,术前按照Krouse分期系统进行临床分级。两组均在全麻状态下进行经鼻内窥镜手术,其中治疗组低温等离子消融切除,对照组电动切割器切除。观察并比较两组手术时间、术中出血量和临床疗效(包括复发率、VAS评分、内镜Lund-Kennedy评分),并对两组各级Krouse分期的手术时间、术中出血情况及临床疗效进行分别比较。结果观察组的手术时间比对照组短(39.71±18.71min:55.44±20.54min),其中分期后治疗组与对照组的手术时间比较:T1期(16.25±5.18min:30.00±6.12min)、T2期(42.62±11.90min:59.52±10.48min)、T3期(65.00±13.69min:91.25±6.29min),比较均有显著性差异(P<0.05);术中出血量,观察组明显少于对照组(27.35±20.53ml:59.71±32.61ml),其中各分期治疗组与对照组出血量比较:T1期(10.00±5.98ml:28.89±9.28ml)、T2期(29.05±19.21ml:61.90±23.16ml)、T3期(48.00±20.49ml:117.5±23.63ml),比较亦均有显著性差异(P<0.05)。术后3个月对患者进行随访,观察组与对照组总VAS评分(10.82±5.83:14.12±7.69),T2期VAS评分(10.81±3.50:14.48±4.33),T3期VAS评分(20.00±6.20:29.25±4.35),观察组均低于相应的对照组,差异具有统计学意义(P<0.05);治疗组及T3期治疗组患者的Lund-Kennedy值均低于相应对照组(0.89±0.76:1.51±1.04)、(1.40±1.14:3.00±0.71),差异具有统计学意义(P<0.05)。随访2年后观察两组复发情况,治疗组2.9%,远低于对照组的23.5%,组间差异有统计学意义(P<0.05)。结论在鼻内翻性乳头状瘤的诊治中,低温等离子射频消融术与电动切割器术相比,不仅临床疗效满意,还能缩短手术时间、减少术中出血量、降低术后复发,值得临床推广。

Application experience of low-temperature plasma ablation in the operation of nasal inverted papilloma

Objective To evaluate the feasibility of low-temperature plasma radiofrequency ablation for the treatment of nasal inverted papilloma and summarize the experience through comparative analysis of low-temperature plasma radiofrequency ablation and electric cutter in the treatment of nasal inverted papilloma.Methods A total of 68 patients with inverted nasal papilloma admitted to our hospital from January 2017 to August 2019 were randomly divided into the treatment group and the control group.Preoperative clinical grading was performed according to the Krouse staging system.Transnasal endoscopic surgery was performed under general anesthesia in both groups.Low-temperature plasma ablation was performed in the treatment group,and the control group was performed by electric suction.Operative time,intraoperative blood loss and clinical efficacy(including recurrence rate,VAS score,endoscopic Lund-Kennedy score)were compared between the two large groups.Operative time,intraoperative blood loss and clinical efficacy at every Krouse stage were compared between the two groups.Results The operation time of the treatment group was significantly shorter than that of the control group(39.71±18.71min:55.44±20.54min).The comparison of operation time between the two groups of different Krouse staging was as follows:T1(16.25±5.18min:30.00±6.12min),T2(42.62±11.90min:59.52±10.48min)and T3(65.00±13.69min:91.25±6.29min),all(P<0.05).The amount of intraoperative blood loss in the treatment group was less than that in the control group(27.35±20.53ml:59.71±32.61ml).The comparison of the amount of blood loss in the two groups of different Krouse staging was as follows:T1(10.00±5.98ml:28.89±9.28ml),T2(29.05±19.21ml:61.90±23.16 mL),T3(48.00±20.49ml:117.5±23.63ml),all with significant differences(P<0.05).Patients were followed up 3 months after surgery,and total VAS score(10.82±5.83:14.12±7.69),T2(10.81±3.50:14.48±4.33),T3(20.00±6.20:29.25±4.35),the treatment group was lower than the corresponding control group,the difference was statistically significant(P<0.05).The Lund-Kennedy score in the treatment group and the T3 treatment group was lower than that in the corresponding control groups(0.89±0.76:1.51±1.04)(1.40±1.14:3.00±0.71),with statistical significance(P<0.05).After 2 years of follow-up,the recurrence rate of 2.9%in the treatment group was much lower than that of 23.5%in the control group,and the difference was statistically significant(P<0.05).Conclusion Compared with electric cutter in the treatment of nasal inverted papilloma,low-temperature plasma not only has satisfactory clinical efficacy,but also can shorten the operation time,reduce intraoperative blood loss and reduce postoperative recurrence rate,which is worthy of clinical promotion.