鼻内窥镜手术切除鼻腔鼻窦内翻性乳头状瘤

［摘要］目的：探讨内窥镜下切除鼻腔鼻窦内翻性乳头状瘤的效果。方法：对15例鼻腔鼻窦内翻性乳头状瘤患者施行鼻内窥镜手术。结果：随访2～4年,仅1例复发,余者均未见复发。结论：鼻内窥镜有多视角、清晰度高、损伤小、不毁容等优点,是治疗鼻腔鼻窦内翻性乳头状瘤的一种很好的方法。     

鼻腔鼻窦内翻性乳头状瘤的外科治疗

目的 :总结鼻腔鼻窦内翻性乳头状瘤外科治疗经验。方法 :收集自 1976年 2月至 1997年 10月间行外科治疗的 2 6例鼻腔鼻窦内翻性乳头状瘤的临床资料并进行回顾性分析。结果 :2 6例鼻腔鼻窦乳头状瘤中 8例有癌变 ,癌变率为 30 .8%。均行外科治疗。随访 2～ 5年局部复发 5例 ,其中 3例死亡 (均为乳头状瘤合并有癌变者 )。局部复发率为 19.2 % (5 / 2 6 )。结论 :术中连同上颌骨内壁切除及筛窦整块切除是治疗该病的最佳方法 ,内窥镜鼻窦切除术适用于局限性病变。     

经鼻内镜治疗鼻腔鼻窦内翻性乳头状瘤18例

探讨内镜下切除鼻腔鼻窦内翻性乳头状瘤的效果。方法：对18例鼻腔鼻窦内翻性乳头状瘤患者行鼻内镜手术。结果：随访1～4.5年,仅1例复发。结论：鼻内镜治疗鼻腔鼻窦内翻性乳头状瘤有多视角、清晰度高、损伤小、不毁容等优点。     

鼻腔鼻窦内翻性乳头状瘤的综合治疗及预防复发的效果

目的总结鼻腔鼻窦内翻性乳头状瘤(nasal cavity and paranasal sinuses inverted papilloma,NIP)的临床特点,探讨鼻内镜手术结合局部药物治疗NIP的疗效和术后复发的预防。方法选取2000～2005年间入院治疗的33例NIP患者,在施行鼻内镜手术切除肿瘤的同时进行平阳霉素局部治疗,并进行鼻内镜下随访。根据Krouse分期,T1级5例,T2级17例,T3级11例。结果33例均在鼻内镜下彻底切除肿瘤,无并发症发生。在随访15～60个月期间,均未见复发和恶变病例。结论鼻内镜手术结合局部药物治疗T1～T3级NIP安全、微创,且能够有效控制术后复发,应作为首选的治疗方法。     

鼻内窥镜下鼻腔鼻窦内翻性乳头状瘤切除术的临床研究

目的探讨经鼻内窥镜行鼻腔鼻窦内翻性乳头状瘤切除术的治疗效果.方法对24例内翻性乳头状瘤患者施行鼻内窥镜手术,术后随访12～60个月.结果24例均在鼻内窥镜下完全切除,随访期内22例治愈,2例复发.结论鼻内窥镜手术为鼻腔鼻窦内翻性乳头状瘤治疗提供了较好的方法,其优点是面部不留疤痕,创伤小,手术视野清晰,能够准确完整的切除肿瘤,术后复发率低,值得推广和应用.     

60例鼻腔鼻窦内翻性乳头状瘤的手术疗效分析

目的:探讨鼻腔、鼻窦内翻性乳头状瘤临床治疗结果。方法:对1995年1月至1999年12月间手术治疗的鼻腔、鼻窦内翻性乳头状瘤60例的临床资料进行总结,分析病变范围、手术方式与复发的关系。结果:60例中局部复发7例。根据NIP分期,Ⅱ期、Ⅲ期和Ⅳ期的复发率分别为6.9％(2/29),22.2％(4/18)和1/2。内镜术后复发3例,鼻侧切开术后复发2例,复发率分别为15.0％(3/20)和25.0％(2/8)。结论:病变范围越小,手术效果越好。内镜手术适用于较局限的病变,对广泛病变鼻侧切开术是一种有效的手术方式,改良鼻侧切开术可降低其术后并发症。     

鼻内镜下鼻腔鼻窦内翻性乳头状瘤切除术

目的探讨采用内镜技术切除鼻腔鼻窦内翻性乳头状瘤的治疗效果.方法为鼻腔鼻窦内翻性乳头状瘤11例施行鼻内镜手术,术后随访6～70个月.结果11例均在鼻内镜下完整地切除肿瘤,无复发.结论鼻内镜手术不仅对局限的鼻腔前部内翻性乳头状瘤有良好的效果,而且对广泛侵犯到后组筛窦和蝶窦的内翻性乳头状瘤有较好的治疗效果,术后复发率低.     

Attachment-oriented endoscopic surgical management for inverted papillomas in the nasal cavity and paranasal sinuses

ObjectiveThe treatment of all forms of sinonasal inverted papilloma (IP) is a complete, wide, local resection. The main surgical purpose is to remove all diseased mucosa and mucoperiosteum, together with a cuff of normal-looking mucosa at the attachment site, followed by drilling and/or coagulation. Our aim is to present our experiences in endoscopic surgical management of IP by using attachment-oriented excision.MethodsWe present 20 cases of sinonasal IP. The data collected includes the histopathological diagnosis, staging, extension of the tumor, tumor attachment site, approach to surgery, serum squamous cell carcinoma antigen (SCCA) level, and recurrences.ResultsAll patients underwent endoscopic surgery. A Caldwell-Luc operation was required in addition to the endoscopic surgery in one case. There was one case of recurrence (5%). After the additional operation, there was no recurrence. The tumor attachment sites vary, and the case of recurrence had a wide attachment site at the primary surgery. No major intra- or post-operative complications were observed.ConclusionThe present study shows that attachment-oriented excision for IP is useful for complete resection of IP. Surgeons should choose the surgical approach according to the location of the tumor attachment site rather than the Krouse staging system.     

鼻内窥镜下鼻腔鼻窦内翻性乳头状瘤切除术

目的 :总结内翻性乳头状瘤的临床特点 ,研究鼻内窥镜下鼻腔鼻窦内翻性乳头状瘤切除术的治疗效果。方法 :对 2 2例内翻性乳头状瘤患者施行鼻内窥镜手术 ,术后随访 2 4个月～ 90个月。结果 :2 2例均在鼻内窥镜下完整地切除肿瘤 ,2例术后 18个月内复发 ,其它 2 0例在随访期内未见复发。结论 :鼻内窥镜手术不仅对局限性的鼻腔前部内翻性乳头状瘤有良好的效果 ,还对病变广泛侵犯到后组筛窦和蝶窦的内翻性乳头状瘤有较好的治疗效果 ,术后复发率很低 ,且有最小破坏性和不影响美观的优点。     

鼻腔及鼻窦内翻性乳头状瘤临床分期中CT的作用

目的探讨鼻腔及鼻窦内翻性乳头状瘤临床分期中CT的应用价值。方法回顾性分析33例鼻腔及鼻窦内翻性乳头状瘤的CT影像资料及手术资料。结果按照Krouse分期标准,将本组病例分为四期(四组)。在每组中将CT分期与手术所见分期比较,结果如下(相符/不相符):T1期1/0,T2期22/2,T3期3/3,T4期2/0,总共28/5。结论鼻腔及鼻窦内翻性乳头状瘤虽无特异CT表现,但CT影像与手术所见对比显示,它能较准确判断肿瘤的侵及范围,是鼻腔及鼻窦内翻性乳头状瘤分期中不可缺少的资料之一。     

鼻腔鼻窦内翻性乳头状瘤治疗体会

目的总结鼻腔鼻窦内翻性乳头状瘤的临床特点和治疗经验.方法对1989年1月～2004年12月间本科收治的38例鼻腔鼻窦内翻性乳头状瘤患者进行了回顾性分析.除1例失访,所有病例随访6个月～5年.结果有18例患者经传统术式（鼻侧切开术和柯-陆术式）切除肿瘤,术后复发率为27.8%.鼻内镜下手术20例（包括3例癌变患者）,除1例侵及颞骨未行根治性手术,其他病例均取得良好疗效.结论鼻内镜手术治疗鼻腔鼻窦内翻性乳头状瘤有其优势.对于较为局限的鼻腔内翻性乳头状瘤癌变的病例,仍可考虑内镜手术.     

鼻内镜下切除鼻腔及鼻窦内翻性乳头状瘤

目的 探讨鼻内镜下切除鼻腔及鼻窦内翻性乳头状瘤的治疗效果.方法 根据Krouse的分期,回顾性分析30例行鼻内镜手术并运用内镜随访24个月Ⅰ～Ⅲ级鼻腔及鼻窦内翻性乳头状瘤患者的临床资料.结果 30例均在鼻内镜下彻底切除肿瘤,无并发症发生.1例在手术后10个月复发恶变;2例分别在术后6和7个月复查时出现复发,咬除并以微波烧灼病变及基底黏膜,其后的随访中未出现复发;其余病例术腔光滑,在随访期间均未见复发.本组复发率为10%,恶变率为3.3%.结论 鼻内镜下切除鼻腔及鼻窦内翻性乳头状瘤,有良好的治疗效果,术后复发率较低.     

改良面中部揭翻加激光辅助治疗鼻腔鼻窦广泛性内翻性乳头状瘤

目的探讨面中部揭翻加激光治疗鼻腔鼻窦广泛性内翻性乳头状瘤的疗效.方法采用改良面中部揭翻加激光切除鼻腔鼻窦广泛性内翻性乳头状瘤32例.结果32例的切口均I期愈合,无并发症.随访6个月至4年,32例中复发3例,2次手术后未再复发.结论改良面中部揭翻加激光是治疗鼻腔鼻窦广泛性内翻性乳头状瘤可靠且有效的方法.     

Radiation therapy in inverted papillomas of the nasal cavity and paranasal sinuses

PURPOSE: Between December 1969 and September 1989, a total of 10 patients with advanced and/or recurrent inverted or cylindrical cell papillomas were treated with irradiation at the University of Florida in Gainesville. MATERIALS AND METHODS: Nine of 10 patients had 1 or more recurrences before they received radiation therapy. Three patients were treated with irradiation alone, and 7 patients received surgery and irradiation (preoperatively in 1 patient and postoperatively in 6 patients). Eight patients had inverted papillomas (3 with concomitant squamous cell carcinoma), and 2 patients had cylindrical cell papillomas. Results: Local recurrence developed in 4 patients at 1.5, 6.5, 12, and 13 years after treatment. No evidence of recurrence was observed in 6 patients at 7, 8.5, 8.5, 9, 9, and 20.5 years after treatment. Four patients died of intercurrent disease. No patient developed a malignant transformation. Significant complications of treatment included, in 1 patient, an area of bone exposure in the orbit that necessitated debridement. CONCLUSION: Surgery is the primary treatment of this entity. Radiation therapy should be considered in patients with incompletely resectable lesions, multiply recurrent tumors, and tumors associated with malignancy.     

不同术式治疗鼻腔鼻窦内翻性乳头状瘤疗效的比较观察

目的比较三种不同手术方式治疗鼻腔鼻窦内翻性乳头状瘤的疗效.方法分别采用鼻侧切开术、改良面中部揭翻径路联合鼻内镜手术及鼻内进路联合鼻内镜手术治疗鼻腔鼻窦内翻性乳头状瘤62例,对其治疗效果进行比较分析.结果经术后随访半年～11年,各组患者症状均消失或减轻.鼻侧切开术36例中复发8例(22.2%),改良面中部揭翻径路联合鼻内镜手术18例中,复发2例(11.1%),鼻内进路联合鼻内镜手术8例中复发1例(12.5%).复发者再次手术后治愈.结论改良面中部揭翻径路联合鼻内镜手术是治疗鼻腔鼻窦内翻性乳头状瘤可靠且有效的方法.     

鼻内镜下手术治疗鼻腔及鼻窦内翻性乳头状瘤

目的探讨鼻内镜下鼻腔及鼻窦内翻性乳头状瘤切除术的治疗效果及其复发的防治。方法16例鼻腔及鼻窦内翻性乳头状瘤患者实施鼻内镜手术,术中、术后局部用抗肿瘤药5-氟脲嘧啶(5-Fu)冲洗及贴敷。结果16例病人随访8个月￣42个月,1例术后30个月复发,其他15例未见复发,全部病例无并发症出现。结论鼻内镜下手术治疗鼻腔及鼻窦内翻性乳头状瘤具有效果好、复发率低、面部不留瘢痕等优点。     

Inverted papilloma of the nasal cavity and paranasal sinuses: clinical data, surgical strategy and recurrence rates

BACKGROUND: In the last decade inverted papillomas of the nasal cavity and paranasal sinuses have been observed in increasing numbers, and treatment modalities have ranged from extensive open radical procedures to microinvasive endonasal surgical excision. OBJECTIVE: To establish criteria for selecting patients for open osteoplastic or endonasal surgery according to clearly defined pathological and clinical data. MATERIAL AND METHOD: In a retrospective study, clinical data of 55 patients treated surgically in the University ENT Clinic Giessen from 1991 to 1998 were analysed. In 33 patients (60%) endonasal excision of the papillomas was carried out and in 22 (40%) osteoplastic lateral rhinotomy or maxillotomy were performed. All histological specimens were revised. Patients were followed up and endoscopically examined until 31 March 1999. RESULTS: In 22 patients, tumours involving the frontal sinus, maxillary sinus, parts of the frontal skull base and anterior ethmoid, and the orbit were operated on using open osteoplastic procedures, with 4 (18%) recurrences observed. Tumours excised endonasally showed the same recurrence rate: 6 out of 33 (18%). These tumours were smaller in size and localized in the nasal cavity, the middle and posterior parts of the ethmoid involving the sphenoid, and the medio-posterior wall of the maxillary sinus. The functional outcome was excellent for all patients; two patients developed a mucocele. Cancerization was observed in three cases. CONCLUSIONS: In select cases the endonasal microsurgical approach to inverted papillomas has the same good results concerning function and tumour control as osteoplastic open rhinotomy. This method should still be preferred in tumours localized in the frontal sinus, anterior ethmoid. anterior. caudal and lateral parts of the maxillary sinus and beyond the sinuses.