Minimally invasive resection of frontal recess/sinus inverted papilloma

OBJECTIVE: Inverted papilloma (IP) in the frontal recess/sinus poses a unique surgical challenge given the inherent difficulty in endoscopic visualization and limitations in access posed by the anatomic confines of the frontal recess/sinus. The objective of this study is to evaluate the efficacy of the minimally invasive endoscopic approach for resection of frontal recess/sinus IP. STUDY DESIGN: Retrospective chart review. METHODS: Five patients with frontal recess/sinus IP comprised the focus of this study. Patient charts were reviewed for demographic data, tumor location and extent, histopathology, surgical treatment strategy, operative parameters (operative time, blood loss), recurrence rate, and follow-up. RESULTS: The average age was 55 years, and all patients were men. All patients underwent computer-aided endoscopic resection of histologically proven IP as the primary surgical modality. Adjunct approaches including endoscopic frontal trephination and modified endoscopic Lothrop were performed in 1 case each. No intra- or postoperative complications occurred in the patient group. No recurrences were noted by endoscopic and/or radiographic surveillance at mean follow-up of 16.8 months. CONCLUSIONS: The minimally invasive endoscopic approach is effective for successful resection of frontal recess/sinus IP. Adjunctive open approaches or extended frontal drill-out approaches may be required to achieve complete tumor extirpation. Careful preoperative planning coupled with meticulous surgical technique are absolute requisites for successful management of these difficult tumors.     

鼻内镜下微创手术治疗内翻性乳头状瘤

目的探讨鼻内窥镜下使用电动切割器微创手术治疗鼻腔鼻窦内翻性乳头状瘤的可行性及疗效 .方法鼻腔鼻窦内翻性乳头状瘤39例中12例前期有1～3次经鼻或鼻侧切开手术史.入院后常规鼻内窥镜及鼻窦CT检查,肿物局限于鼻腔(鼻甲、中隔、鼻道)者3例,单侧一窦或多窦受累者35例,双侧鼻窦受累者1例,均未发现眶内及颅内受侵.34例在局麻加强化麻醉下行鼻内镜微创手术, 5例因广泛累及上颌窦加用鼻内镜下柯-陆氏手术,术中均用电刀电凝肿瘤基底部及可疑肿瘤残余处,全部病例均获随访2～60个月.结果39例中2例术后复发,复发率为5.13%.1例术后1年复发,因累及眶内故在全麻下行鼻侧切开肿物切除术,手术病理报告为纤维肉瘤,建议放疗,患者自动出院失访.1例术后9个月复发,门诊复查时见中鼻道有肿瘤样物质,在内镜下用电动切割器切除肿瘤,用电刀电凝肿瘤基底部,病理报告为内翻性乳头状瘤,随访2年未复发.其余37例随访期间均未见复发.结论鼻内窥镜手术治疗内翻性乳头状瘤具有术中出血少,创伤小,术后不留瘢痕,复发率低等优点,电动切割器微创手术具有对正常黏膜刺激小,手术范围准确,术后并发症少,鼻腔上皮化修复快等优点.对肿瘤广泛累及上颌窦者加用鼻内镜下柯-陆氏手术.对疑有恶变的患者采用鼻侧切开术.     

鼻内翻性乳头状瘤临床分型和术式选择

目的研究鼻内翻性乳头状瘤(nasal inverted papilloma,NIP)的临床分型以指导手术。 方法用CT/MRI和鼻内镜检查47例NIP,明确病变起源,制定临床分型并采取相应的术式,术后跟踪随访。结果随访1～8年,Ⅰ型复发率为7.1％,Ⅱ型复发率为10.5％,总复发率为8.5％。首次手术复发率为2.8％,二次手术复发率为27.3％。结论按Reda Kamel的NIP临床分型方法,即根据病变的起源进行临床分型有利于手术方式的选择。     

鼻及鼻窦内翻性乳头状瘤的诊治

目的 比较不同术式治疗鼻及鼻窦内翻性乳头状瘤的疗效.方法 分析163例该病病例,按不同的术式分鼻外进路组,单纯鼻内镜组,鼻内镜联合柯-陆进路组;按病变范围不同分Ⅰ期79例,Ⅱ期68例,Ⅲ期12例,Ⅳ期4例;按上皮细胞的增生异型程度分轻(128例)、中(26例)、重度不典型增生(9例).术后随访6～64个月,比较复发率.结果 临床分期相同的患者三种术式疗效无显著性差异(P＞0.05).总复发率11.04%(18/163),轻、中、重度不典型增生病例术后复发率分别为7.03%(9/128)、15.38%(4/26)、55.56%(5/9),有显著性差异(P＜0.01).结论 临床分期相同的患者采用三种术式疗效相同,术后复发与病变范围和肿瘤的病理分级有密切关系.     

鼻内镜下鼻内翻性乳头状瘤切除术(附46例报告)

目的:总结鼻内翻性乳头状瘤的临床特点,探讨鼻内镜手术切除鼻内翻性乳头状瘤的疗效。方法:对1995~2005年收治的46例鼻内翻性乳头状瘤患者施行鼻内镜手术。结果:46例患者均在鼻内镜下完整切除肿瘤(其中8例联合上颌窦根治术),随访12~72个月,5例术后24个月内复发,其余41例在随访期内未见复发。结论:鼻内镜手术治疗鼻内翻性乳头状瘤是一种安全有效的方法,对肿瘤广泛侵及上颌窦内的Ⅲ级病变联合上颌窦根治术效果较好。     

经鼻内镜上颌骨部分切除术治疗鼻-鼻窦内翻性乳头状瘤

目的〓〖HTK〗探讨在鼻内镜下治疗鼻-鼻窦内翻性乳头状瘤的优点。〖HTW〗方法〓〖HTK〗回顾分析经鼻内镜切除鼻-鼻窦内翻性乳头状瘤与传统术式在出血量、手术时间、并发症发生率及复发率等方面的差异。〖HTW〗结果〓〖HTK〗观察组平均出血80mL,对照组平均500mL。观察组平均手术时间为2h,对照组平均3h。观察组未见严重手术并发症,对照组并发症发生率为7.1%（3/42）。观察组术后复发率14.2%（4/28）,对照组术后复发率35.7%（15/42）。〖HTW〗结论〓〖HTK〗经鼻内镜切除鼻-鼻窦内翻性乳头状瘤是一种有效的治疗方式。     

内窥镜鼻内翻性乳头状瘤切除术

目的探讨和完善鼻内窥镜下彻底切除鼻内翻性乳头状瘤,降低术后复发率的手术方法及其适应证。方法1994年1月～1999年6月住院的临床及病理诊断为鼻内翻性乳头状瘤的患者47例,其中24例有1～3次前期经鼻或鼻侧切开术手术史。经CT、前鼻镜和内窥镜检查,肿瘤侵及中鼻道、上颌窦口和部分或全部筛窦者29例,同时侵及蝶窦者7例,2例肿瘤原发于鼻中隔,肿瘤侵及嗅裂下部、中鼻甲、中鼻道和部分筛窦;9例患者肿瘤除侵及中鼻道、上颌窦口和部分或全部筛窦外,同时广泛侵及上颌窦内。前者采用鼻内窥镜经鼻肿瘤切除术;后者采用鼻内窥镜经鼻肿瘤切除,同时在内窥镜下经上颌窦前壁（Caldwell-Luc术式）或下鼻道开窗联合径路肿瘤切除术。术前、中、后用电刀电凝肿瘤基部或以YAG激光光导纤维插入肿瘤根部和瘤体,术中应用吸切器（shaver     

鼻内翻性乳头状瘤的临床分期与术式选择

目的；探讨鼻内翻性乳头状瘤的临床分期和手术方式选择，以降低复发率。方法：对41例鼻内翻性乳头状瘤，根据病变的 特征将其分期为T1、T2、T3、T4期，据此，19例行鼻内镜手术，20例行鼻侧切开手术，2例行上颌骨部分或全截除术。结果：鼻内镜手术后复发率为10.5％，鼻侧切开术后复发率为15.0％。结论：鼻内翻性乳头状瘤根据CT检查和病变的特征进行临床分期，按分期选择手术方式，可以彻底切除肿瘤，降低术后复发率。     

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。     

内窥镜鼻内翻性乳头状瘤切除术

目的 探讨和完善鼻内窥镜下彻底切除鼻内翻性乳头状，降低术后复发率的手术方法及其适应证。方法 1994年1月－1999年6月住院的临床及病理诊断为鼻内翻性乳头状瘤的患者47例，其中24例有1－3次前期经鼻或鼻侧切开术手术史。经CT、前鼻镜和内窥镜检查，肿瘤侵及中鼻道、上颌窦口和部分或全部筛窦者29例，同时侵及蝶窦者7例，2例肿瘤原发于鼻中隔，肿瘤侵及嗅裂下部、中鼻甲、中鼻道和部分筛窦；9例患者肿瘤除侵及中鼻道、上颌窦口和部分或全部筛窦外，同时广泛侵及上颌窦内。前者采用鼻内窥镜经鼻肿瘤切除术；后者要用鼻内窥镜经鼻肿瘤切除，同时在内窥镜下经上颌窦前壁（Caldwell-Luc术式）或下鼻道开窗联合径路肿瘤切除术。术前、中、后用电刀电凝肿瘤基部以YAG激光光导纤维插入肿瘤根部和瘤体，术中应用吸切器（shaver system）切 除瘤体，于肿瘤基部周围骨膜下剥离，局部骨骼化，注意将肿瘤及其基部粘骨膜一并切除。手术创腔痊愈后1、3、6个月复查，以后随访。全部病例随访12－40个月（平均24．6个月）。结果 47例中2例术后复发，45例未复发，治愈率95．7％。6例（12．7％）术后清理、换药期间发现术腔局部出现瘤样组织，病理检查证实内翻性乳头状瘤，内窥镜下 除并以电力、YAG激光处理局部创面。随诊1年此6例未再发现有瘤样组织。结论 辅以电刀或激光处理术野的内窥镜鼻内翻性乳头状瘤切除术，有利于彻底切除肿瘤。对肿瘤已广泛侵入上颌窦内人者采用联合径路手术。     

鼻内翻性乳头状瘤伴鼻息肉的临床分析

目的:探讨鼻内翻性乳头状瘤伴鼻息肉的临床特征。方法:分别对12例鼻内翻性乳头状瘤伴鼻息肉患者的肿瘤外露部、深部、基底部及窦腔处进行多点取材,并对病理结果进行分析,判断其临床特点及相关性。结果:内翻性乳头状瘤多位于瘤体的深部及基底部,而息肉组织多位于瘤体的表面。结论:鼻内翻性乳头状瘤伴鼻息肉可能是因内翻性乳头状瘤表面上皮组织长期受炎性刺激而局部形成息肉样变的结果,因此对单侧鼻息肉,应警惕深部肿瘤性疾病的可能性。     

经鼻内镜鼻内翻性乳头状瘤切除术远期疗效观察

目的探讨鼻内镜下切除鼻内翻性乳头状瘤的远期效果。方法回顾性分析1996年1月～1999年12月,经鼻内镜鼻内翻性乳头状瘤手术治疗32例的临床资料,其中超过5年随访的患者29例。结果失访3例未纳入统计。29例患者中行单纯鼻内镜手术24例,鼻内镜加柯-陆氏手术5例。经鼻内镜随访至少5年,平均随访7.4年,治愈26例(89.7%),3例复发(10.3%),其中1例癌变。结论经鼻内镜切除鼻内翻性乳头状瘤,损伤小、恢复快、疗效满意,上颌窦内病变范围广泛者鼻内镜加柯-陆氏径路有利于减少手术复发。     

Incidence of inverted papilloma in recurrent nasal polyposis

OBJECTIVES: A diagnosis of inverted papilloma in apparently normal bilateral polyps is a possible albeit rare event. The frequency of this diagnosis varies between 0.00% and 0.92%. There are no studies evaluating whether this possibility is significantly different in patients operated for recurrence when compared with those undergoing first surgery. The aim of this study is to evaluate the frequency of inverted papilloma in a series of histologic specimens obtained from patients undergoing surgery for recurrent nasal polyposis. METHODS: The authors conducted a retrospective chart and pathologic review of data from 1887 surgical interventions for removal of unremarkable bilateral nasal polyps. Frequency of inverted papilloma was assessed. RESULTS: Five cases of inverted papilloma were identified. The incidence of this diagnosis was thus 0.26% (95% confidence interval, 0.08-0.62%). Age, gender, and number of recurrences did not influence the frequency of this diagnosis. CONCLUSIONS: The occurrence of inverted papilloma in unremarkable recurrent cases of nasal polyps is rare. This rate is similar to the one observed in patients undergoing first surgery.     

Huge hamartoma with inverted papilloma in the nasal cavity

We report clinical experience in managing a 46-year-old Japanese man with long-standing nasal obstruction resulting from a huge left nasal mass. Computed tomography, magnetic resonance imaging and biopsy were used to make a provisional diagnosis of inverted papilloma. The mass was resected via a frontal approach combined with rhinotomy. Histopathologic examination of the resected specimen was consistent with a hamartoma that included an inverted papilloma on a portion of its surface. In addition to being rare tumors in the nasal cavity, we believe that our patient’s tumor the largest nasal hamartoma ever reported.     

Huge hamartoma with inverted papilloma in the nasal cavity

We report clinical experience in managing a 46-year-old Japanese man with long-standing nasal obstruction resulting from a huge left nasal mass. Computed tomography, magnetic resonance imaging and biopsy were used to make a provisional diagnosis of inverted papilloma. The mass was resected via a frontal approach combined with rhinotomy. Histopathologic examination of the resected specimen was consistent with a hamartoma that included an inverted papilloma on a portion of its surface. In addition to being rare tumors in the nasal cavity, we believe that our patient's tumor the largest nasal hamartoma ever reported.     

影像导航技术在鼻腔鼻窦内翻性乳头状瘤手术中的应用

目的 探讨影像导航技术在鼻腔鼻窦内翻性乳头状瘤(NIP)手术中的应用价值 。方法 将68例行手术治疗NIP患者按时间顺序分为前、后两组,前组应用鼻内镜手术或鼻内镜手术+传统术式（2001年5月～2004年12月）34例,后组以前组术式为基础加用影像导航技术（2005年1月～2007年6月）34例,对两组术后复发率进行比较。结果 应用影像导航技术的后组术后复发率低于前组,差异有统计学意义（P＜0.05）。 结论影像导航技术在鼻腔鼻窦内翻性乳头状瘤手术中能进行三维重建,具有定位准确、影像立体,不受组织移位和解剖复杂影响的优点,可降低术后的复发率。     

鼻内镜下溯源法切除鼻内翻性乳头状瘤的临床分析

目的 探讨鼻内镜下溯源法切除鼻内翻性乳头状瘤（NIP）的临床疗效与经验总结。方法 回顾性分析2013年1月—2017年6月南京大学医学院附属鼓楼医院耳鼻咽喉头颈外科收治的71例采用鼻内镜下溯源法切除NIP患者的临床资料,统计患者精确定位起源部位与不能精确定位起源部位的复发情况。结果 71例患者术后均无严重并发症,随访1年内4例患者复发,复发率为5.6%,其中术中能精确定位唯一起源部的NIP患者1年复发率为3.0%（2/67）,而不能精确定位者复发率为50.0%（2/4）。结论 鼻内镜下溯源法切除NIP对控制肿瘤复发具有优势。彻底切除肿瘤及术后定期随访是治疗成功的关键。     

Our experience in treatment of patients with inverted papilloma of lateral nasal wall

Inverted papilloma is a benign neoplasm of uncertain etiology arising from the lateral nasal wall and middle meatus. The tumour is considered locally aggressive. In selected cases inverted papilloma can be associated with squamous cell carcinoma. Computed tomography and magnetic resonance imaging are widely used for diagnosis and preoperative workup to evaluate the degree of sinus involvement. Its tendency to invade adjacent paranasal structures and high recurrence rate causes controversy as to the optimal method of surgical removal. During the past decade, endoscopic surgical approaches have become accepted as standard of care in case of inverted papilloma. Continually increasing skill with the use of the endoscopes and a better understanding of the anatomy of the region have allowed surgeons to extend the applications of sinus endoscopic surgery. The following paper reports clinical outcome of treatment of 20 patients with inverted papilloma of the lateral nasal wall treated in ENT University Department in Kraków, provides review of current literature concerning the subject and discusses indications and contraindications of this method of treatment in comparison with traditional extranasal approaches in order to search for the optimal philosophy of sinus surgery for inverted papilloma.     

Co-existent inverted papilloma and squamous carcinoma of the nasal septum

Inverted papilloma is an uncommon benign nasal tumour which usually occurs on the lateral nasal wall and is prone to recurrence and malignant change. Inverted papilloma of the nasal septum is rare. A case of inverted papilloma and coexistent squamous carcinoma of the nasal septum in an adult male is described. The biology and treatment of these lesions are discussed.