鼻腔鼻窦内翻性乳头状瘤三种手术方式治疗的随机对照研究

目的:分析鼻内镜手术、鼻侧切手术及鼻内镜联合柯-陆手术治疗鼻腔鼻窦内翻性乳头状瘤（NIP）的临床疗效，比较3种手术的适用范围。方法:将141例NIP患者采用随机平行对照研究的方式，分为鼻内镜组、鼻侧切组及鼻内镜联合柯-陆手术组，分析3种手术的疗效，并随访并发症及复发率。结果:鼻内镜组、鼻侧切组及鼻内镜联合柯-陆手术组患者的手术时间、术中出血量及术后住院时间差异均有统计学意义（P<0.01）；随访1年内，鼻内镜组5例患者失访，鼻侧切组7例失访，鼻内镜联合柯-陆手术组3例失访；3组患者不同Krouse分期下的Ⅰ型、Ⅱ型、Ⅳ型总的复发率差异均无统计学意义（P>0.05）；鼻内镜联合柯-陆手术组Krouse Ⅲ型患者的复发率与鼻内镜组及鼻侧切组差异有统计学意义（P<0.05）；3组患者不同Krouse分期下的Ⅰ型、Ⅱ型、Ⅳ型并发症发生率及总并发症发生率差异均无统计学差异（P>0.05）；鼻内镜组及鼻侧切组患者的Krouse分期下Ⅲ型患者并发症发生率均高于鼻内镜联合柯-陆手术组（P<0.05）。结论:鼻内镜手术治疗NIP患者具有手术时间短、出血量少及住院时间短等优势，对于Krouse分期Ⅰ~Ⅱ期的患者更适合；对于Krouse分期Ⅲ期的患者采用鼻内镜联合柯-陆手术可显著减少手术并发症及复发率，对Krouse分期Ⅳ期的患者上述3种手术疗效均不理想。

Three operation methods in the treatment of nasal inverted papilloma:a randomized controlled study

Objective:To compare the clinical effects between endoscopic sinus surgery,nasal incision and endoscopic Caldwell-Luc surgery in the treatment of nasal inverted papilloma(NIP),and explore the application of three kinds of operations. Methods:One hundred and forty-one NIP patients were randomly divided into the endoscopic sinus surgery group,nasal incision group and endoscopic Caldwell-Luc surgery group using randomized parallel controlled study way. The clinical effects, complications and recurrence rate between the three kinds of operations were analyzed. Results:The differences of the operation time, blood loss and postoperative hospitalization time between three groups were statistically significant(P>0. 01). During the following up period,5 cases in endoscopic sinus surgery group,7 cases in nasal incision group and 3 cases in endoscopic Caldwell-Luc surgery group lost to follow. The differences of the total recurrence rate,incidence of complication and total complications in type Ⅰ,Ⅱ and Ⅳ Krouse between three groups were not statistically significant(P>0. 05). The differences of the recurrence rates in patients with typeⅣKrouse between three groups were statistically significant(P<0. 05). The incidences of complication in patients with type Ⅳ Krouse in endoscopic sinus surgery group and nasal incision group were higher than that in endoscopic Caldwell-Luc surgery group(P<0. 05). Conclusions:The endoscopic sinus surgery in the treatment of nasal inverted papilloma is short operation time,little bleeding and short hospital stay,which is more suitable for the patients with typeⅠtoⅡKrouse. The treatment of typeⅢKrouse with endoscopic Caldwell-Luc surgery can significantly reduce complications and recurrence rate,the effects of typeⅣKrouse patients treated with three kinds operation are not ideal.