不同术式治疗鼻腔鼻窦内翻性乳头状瘤疗效观察

鼻腔鼻窦内翻性乳头状瘤(nasal inverted papilloma,NIP)是一种较常见的上皮源性良性肿瘤,多发生于鼻腔外侧壁、上颌窦及筛窦,具有局部侵袭性强、易复发、易恶变等特点。完整彻底的手术切除是降低肿瘤复发率的关键。其发病率约占鼻腔鼻窦肿瘤的0.5%～4%,因其局部破坏性强,具     

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.     

鼻腔鼻窦内翻性乳头状瘤手术治疗的疗效分析

目的：观察鼻内镜下鼻腔鼻窦内翻性乳头状瘤手术治疗的临床疗效。方法回顾性分析在我院诊治的鼻腔鼻窦内翻性乳头状瘤患者56例,采用鼻内镜或鼻内镜联合Caldwell-Luc手术治疗,总结其临床疗效。结果56例患者术后效果良好,无严重并发症发生。术后随访2年,6例病变复发,2例术腔存在炎性肉芽组织,48例痊愈,治愈率85.7%。结论鼻内镜手术是治疗鼻腔鼻窦内翻性乳头状瘤的有效手段。应根据肿瘤侵犯的范围不同而采取不同的术式,术后宜定期复查,以便及时妥当处理局部病变。     

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月问手术治疗的鼻腔、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。     

鼻腔鼻窦内翻性乳头状瘤的手术治疗

鼻腔鼻窦内翻性乳头状瘤是鼻腔良性肿瘤，但因其侵袭性强、复发率高及有一定的恶变率而受到临床的重视。外科手术治疗是鼻腔鼻窦内翻性乳头状瘤的主要治疗方法，过去常规运用鼻外径路方法，主要包括鼻侧切开术和面正中掀翻术切除肿瘤。近年部分学者对鼻腔鼻窦内翻性乳头状瘤采用鼻内镜手术治疗，取得良好的近期疗效。     

鼻腔鼻窦内翻性乳头状瘤的手术治疗

鼻腔鼻窦内翻性乳头状瘤是由于表层上皮过度增生,向基质内呈乳头状增生所致,是一种真性上皮肿瘤,虽属良性肿瘤,却因其破坏性生长,术后易复发,较易恶变,对放射线不敏感等特点,手术切除必需彻底,临床选择适当的手术方式尤为重要.本文总结我科1987年1月～2004年1月收治的56例鼻腔鼻窦内翻性乳头状瘤,采用3种术式,取得较好疗效.现报道如下.     

鼻内镜手术治疗鼻腔鼻窦内翻性乳头状瘤疗效观察

目的探讨经鼻内镜手术治疗鼻腔鼻窦内翻性乳头状瘤的疗效。方法回顾性分析28例经鼻内镜手术治疗的鼻腔鼻窦内翻性乳头状瘤的病例资料及术后随访情况。结果随访10—36个月,28例中5例复发,再次经鼻内镜手术后未再复发。结论鼻内镜手术视野清晰、创伤小、效果满意,是治疗鼻腔鼻窦内翻性乳头状瘤优先选择的方法。准确的术前评估、手术技巧和术后定期随访是影响疗效的主要因素。     

鼻腔鼻窦内翻性乳头状瘤人类乳头状瘤病毒DNA检测

为了解鼻腔鼻窦内翻性乳头状瘤与人类乳头状瘤病毒（ＨＰＶ）之间的关系，采用聚合酶链反应，对３８例患者的４４个鼻腔鼻窦内翻性乳头状瘤的病理组织蜡块进行ＨＰＶ－ＤＮＡ的检测。结果显示，３８例中３０例患者的３０个瘤组织蜡块呈ＨＰＶ阳性，总感染率为６８．２％，其中３０例次ＨＰＶ１１型阳性（６８．２％），１８例次ＨＰＶ１６型阳性（４０．９％），２例次ＨＰＶ１８型阳性（４．５％），其中１８例ＨＰＶ１１，１６、２     

双侧鼻腔鼻窦内翻性乳头状瘤1例

1病例报告患者,男,83岁。自述十余年前无明显诱因出现双侧鼻塞,呈持续性,时有黄脓涕及头部闷胀感,上述症状渐进性加重,逐渐出现闭塞性鼻音,夜间睡眠张口呼吸,偶有憋醒,嗅觉丧失;无涕中带血及     

鼻腔鼻窦内翻性乳头状瘤

内翻性乳头状瘤约占乳头状瘤的70%,约占全部鼻腔鼻窦肿瘤的0.5%～4%,其临麻特征是有复发倾向、破坏周围解剖结构和骨质重塑、以及与鳞状细胞癌相关。单侧鼻堵是最常见的临床症状。肿瘤分期依据病变在CT上的侵及范围。累及鼻腔外侧壁、上颌窦和筛窦多见。既往治疗的经典方式是鼻侧切开术和鼻腔外侧壁(上颔窦内侧壁)切除术。伴随着鼻内镜外科技术的发展和成熟,国内、外有关应用内镜技术切除内翻性乳头状瘤的报道渐多。考虑到内翻性乳头状瘤的生物学特点,手术治疗的目的是应用精细手术解剖技术,将病变黏膜在骨膜下层彻底切除。     

双进路鼻腔鼻窦内翻性乳头状瘤切除术

目的 探讨鼻腔鼻窦内翻性乳头状瘤的手术疗法。方法 对25例单侧鼻腔内翻性乳头状瘤患者进行鼻内窥镜和柯－陆氏双进路手术，除去病变。结果 术后随访时间1．5年，复发3例，复发率12．0％。结论 该方法融合了鼻内窥镜及柯－陆氏手术的长处，可彻底清除鼻腔、筛窦及上颌窦的肿瘤，降低了该病的复发率。     

38例鼻腔鼻窦内翻性乳头状瘤鼻内镜下切除术回顾性分析

目的分析鼻内镜手术在鼻腔鼻窦内翻性乳头状瘤外科治疗中的应用。方法38例鼻腔鼻窦内翻性乳头状瘤患者,于鼻内镜下(或结合下鼻道开窗及犬齿窝穿刺术)行肿瘤切除术,观察手术效果。结果38例患者中,术后仅有4例出现局部复发,再次鼻内镜下局部清理后治愈。本术式可用于大多数比较局限的鼻腔鼻窦内翻性乳头状瘤的切除,具有损伤小,不遗留面部瘢痕的优点。结论对经严格选择的鼻腔鼻窦内翻性乳头状瘤病例,鼻内镜下可较准确地判断肿瘤的原发部位及其范围,能够最大程度的完整切除肿瘤。     

Isolated inverting papilloma of the sphenoid sinus

OBJECTIVES/HYPOTHESIS: Primary inverting papilloma of the sphenoid sinus is rare. We present a case of inverting papilloma with isolated involvement of the sphenoid sinus and discuss the incidence, clinical presentation, radiographic features, histological findings, and management of patients with this disease. STUDY DESIGN: Case report. METHODS: The medical records, films, and pathology slides of a patient with isolated inverting papilloma of the sphenoid sinus seen at University of California Los Angeles Medical Center were reviewed. The clinical presentation, radiographic features, histopathological findings, treatment, and outcome of the case were examined. RESULTS: A single case of inverting papilloma with isolated involvement of the sphenoid sinus is presented. Headache and diplopia were the presenting complaints, as is often seen with other isolated sphenoid sinus lesions. Endoscopic intranasal sphenoid sinusotomy was performed, and no evidence of recurrent disease has been seen after 6 months of follow-up. CONCLUSIONS: Isolated inverting papilloma of the sphenoid sinus is a rare phenomenon. In contrast to the vast majority of cases that present with nasal complaints (i.e., unilateral nasal obstruction, epistaxis) because of involvement of the lateral nasal wall, the clinical presentation of inverting papillomas confined to the sphenoid sinus is often nonspecific and insidious, with visual deficits being the predominant feature. Nevertheless, functional endoscopic intranasal sphenoidotomy remains an effective mode of treatment for patients with these lesions.     

A study of surgical procedures for inverted papilloma in the nasal cavity and paranasal sinuses

Inverted papilloma, although benign, recurs frequently and may become malignant, making definitive initial resection extremely important. We evaluated surgical procedures for recurrence and sites, with special reference to management of the orbital plate of the ethmoid and lacrimal bones, in 24 patients (32 cases) with inverted papilloma of the nasal cavity and paranasal sinuses undergoing surgical resection from 2000. Nine of the 32 showed recurrence, all around the ethmoid orbital plate. Up to 2002, recurrence was noted in 7 of 17 cases (41%), so we changed surgical selection criteria. Since 2003, we have conducted partial and combined excision of the orbital plate of the ethmoid and lacrimal bones (extended operation of the extranasal ethmoid and frontal sinuses) in cases in which tumors adhered to the orbital plate, noting recurrences in only 2 of 15 cases (13%). A number of reports advocate endoscopic sinus surgery to minimize invasiveness for inverted papilloma, but partial and combined excision of the orbital plate is indispensable, in progressive inverted papilloma cases to reduce recurrent.     

An evolution in the management of sinonasal inverting papilloma

OBJECTIVE: We reviewed the 15-year experience of our institution (Medical College of Wisconsin, Milwaukee, WI) in managing sinonasal inverting papilloma, examining trends in diagnosis and treatment. STUDY DESIGN: Retrospective. METHODS: Thirty-seven patients with inverting papilloma were treated from 1986 to 1999. Demographic data, clinical presentations, pathological findings, surgical approaches and procedures, and recurrence rates were collected retrospectively. Each lesion was categorized into one of four groups based on computed tomography scans and endoscopic findings. This categorization was developed to compare various surgical approaches for tumors in each group. RESULTS: Thirty-one patients had complete information for inclusion in our study. Nineteen patients were treated endoscopically with an average follow-up of 50 months. Eight patients were in group I, five were in group II, six were in group III, and no patients were in group IV. The recurrence rate for the endoscopic group was 10%. Twelve patients underwent lateral rhinotomy or sublabial degloving approach with an average follow-up of 58 months. Five patients were in group I, three patients were in group II, 1 patient was in group III, and three patients were in group IV. The recurrence rate for the external group was 8%. Difference in recurrence rates (P =.85) was not observed between the endoscopic and external approach groups. Regardless of approach, patients who had primary resection had a recurrence of 0%, whereas those with secondary resection had a recurrence of 17% (P =.10). CONCLUSIONS: Technological advancements have led to a trend of detecting sinonasal inverting papilloma before extension beyond the sinonasal region. Difference in recurrence rates was not observed between the endoscopic and the external approach groups. Recurrence rates are lower for primary resection versus secondary resection, regardless of surgical approach.     

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.     

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。