鼻内镜下切除治疗鼻腔鼻窦内翻性乳头状瘤的临床研究

目的]探讨鼻内镜下切除鼻腔鼻窦内翻性乳头状瘤(NIP)的治疗效果和可行性。方法]回顾性分析2005年10月～2010年8月行手术治疗的100例NIP患者的临床资料,行鼻侧切开术治疗57例(鼻侧切开组),行鼻内窥镜手术治疗42例(鼻内镜组)。术后随访1～3年,平均(32±11)个月,观察术后复发率和并发症发生率。结果]鼻内镜组术后肿瘤复发率为18.6%,显著低于鼻侧切开组(29.3%),差异有统计学意义(χ2=6.574,P﹤0.01);Ⅱ、Ⅲ级患者术后肿瘤复发率均显著低于鼻侧切开组,差异有统计学意义(χ2=9.150、5.648,P﹤0.01);Ⅳ级患者术后肿瘤复发率显著高于鼻侧切开组,差异有统计学意义(χ2=9.100,P﹤0.01)。鼻内镜组术后并发症发生率为9.3%,显著低于鼻侧切开组(24.6),差异有统计学意义(χ2=8.200,P﹤0.01);Ⅱ、Ⅲ级患者术后并发症发生率均显著低于鼻侧切开组,差异有统计学意义(χ2=7.721、6.102,P﹤0.01);Ⅳ级患者术后并发症发生率均显著高于鼻侧切开组,差异有统计学意义(χ2=9.019,P﹤0.01)。而两组Ⅰ级患者术后肿瘤复发率和并发症发生率比较差异无统计学意义(χ2=1.761,2.361,P﹥0.05)。结论]鼻内镜下切除治疗NIP临床效果好,术后复发率低、并发症少,但在治疗NIP时应根据Krouse分级选择合适的术式。

CLINICAL RESEARCH ON THE ENDOSCOPIC APPROACH IN TREATMENT OF PATIENTS WITH NASAL CAVITY AND SINUSES INVERTED PAPILLOMA

Objective]To investigate the clinical effects and feasibility of endoscopic approach for treating the patients with nasal cavity and sinuses inverted papilloma(NIP).Methods]The clinical data of 100 patients with NIP was retrospectively analyzed from October 2005 to August 2010,57 cases were given the surgery of lateral rhinotomy(lateral rhinotomy group),42 cases were given the surgery of endoscopic approach(endoscopic approach group).Patients were followed up 1 to 3 years,the average(32 ± 11)months,the postoperative recurrence rate and complication rate of the two groups were observed.Results]The postoperative recurrence rate of the endoscopic approach group was 18.6%,the lateral rhinotomy group was 29.3%,the difference was significant(χ2 = 6.574,P﹤0.01);TheⅡ and Ⅲ grade’s postoperative recurrence rate of endoscopic approach group was lower than lateral rhinotomy group,and the difference was significant(χ2 = 9.150,5.648,P﹤0.01);The Ⅳ grade’s postoperative recurrence rate of endoscopic approach group was higher than lateral rhinotomy group,and the difference was significant(χ2 = 9.100,P﹤0.01).The postoperative complication rate of the endoscopic approach group was 9.3%,and the lateral rhinotomy group was 24.6%,and the difference was significant(χ2 = 8.200,P﹤0.01);TheⅡ and Ⅲ grade’s postoperative complication rate of endoscopic approach group was lower than lateral rhinotomy group,and the difference was significant(χ2 = 7.721、6.102,P﹤0.01);The Ⅳ grade’s postoperative complication rate of endoscopic approach group was higher than lateral rhinotomy group,and the difference was significant(χ2 = 9.019,P﹤0.01).The postoperative recurrence rate and complication rate of the two groups were no significant difference(χ2 = 1.761,2.361,P﹥0.05).Conclusion]The endoscopic approach surgery for treating the patients with NIP has good clinical effect,low recurrence rate and few complications.However,we should select the appropriate approach of surgery according to Krouse classification for treating the NIP