鼻内翻性乳头状瘤的术式选择和疗效分析

目的 探讨鼻内翻性乳头状瘤(NIP)的手术治疗策略及相应疗效情况。 方法 回顾性分析2010年10月至2016年10月收治的181例NIP患者的临床资料。患者术前均行鼻内镜、CT或MRI检查,明确病变范围,根据Krouse分期系统进行临床评级,综合评估并制定手术方法,其中鼻内镜手术124例,鼻侧切开术27例,鼻内镜联合柯-陆式手术30例。术后随访1~6年。 结果 181例NIP患者术后总复发率为17.7%(32/181),其中鼻内镜手术复发率为15.3%(19/124),鼻侧切开术复发率为25.9%(7/27),鼻内镜联合柯-陆式手术复发率为20.0%(6/30),差异无统计学意义(P>0.05)。对不同分级患者术后复发率进行统计,其中Ⅰ级复发率为11.8%(2/17),Ⅱ级复发率为11.6%(8/69),Ⅲ级复发率为17.2%(11/64),Ⅳ级复发率为35.5%(11/31),级别越高复发率相对越高;各级之间术后复发率差异有统计学意义(P<0.05)。 结论 鼻内镜手术已成为NIP主要治疗方式,疗效与鼻外径路术式相仿。高分级NIP复发率较高,而合理选择术式彻底切除肿瘤及严格的术后随访则是其治疗成功的关键。

Surgical strategies for nasal inverted papilloma and corresponding recurrence rates

Objective To investigate the surgical strategies for nasal inverted papilloma(NIP)and the corresponding recurrence rates. Methods The clinical data of 181 patients admitted to our hospital from October 2010 to October 2016 with NIP were retrospectively analyzed. All patients underwent nasal endoscopy, computed tomography(CT), or MRI examination before surgery to determine the extent of the disease. Clinical evaluations were made according to the Krouse staging system, and patients were scheduled for surgery. Of those, 124 patients underwent endoscopic sinus surgery, 27 underwent nasal resection, and 30 underwent endoscopic surgery combined with Caldwell-Luc surgery. All were followed up for 1 to 6 years. Results The total postoperative recurrence rate for the 181 NIP patients was 17.7%(32/181). The recurrence rates by surgery type were as follows: endoscopic sinus surgery, 15.3%(19/124); nasal resection, 25.9%(7/27); and endoscopic sinus surgery combined with Caldwell-Luc surgery, 17.7%(32/181). There were no significant differences between the three groups(P>0.05). The recurrence rates for patients with different Krouse staging scores were statistically analyzed. The recurrence rates for grade Ⅰ, grade Ⅱ, grade Ⅲ, and grade Ⅳ lesions were 11.8%(2/17), 11.6%(8/69), 17.2%(11/64), and 35.5%(11/31), respectively. The recurrence rate increased with tumor grade at the time of surgery. There were significant differences in recurrence rates among all stages(P<0.05). Conclusion Endoscopic sinus surgery has become the main treatment for NIP, and the recurrence rate observed was similar to that for endoscopic sinus surgery combined with Caldwell-Luc surgery. The rate of postoperative recurrence increased with the stage of NIP at the time of surgery. Choice of surgical procedure, complete removal of the tumor, and strict follow-up are key to successful treatment.