不同手术方式治疗鼻腔鼻窦内翻性乳头状瘤的临床分析

目的比较不同手术方式治疗不同临床分级的鼻腔鼻窦内翻性乳头状瘤的疗效。方法选取60例鼻腔鼻窦内翻性乳头状瘤患者，17例采用鼻外入路，27例采用单纯鼻内镜，16例采用鼻内镜下联合柯一陆手术。比较三种手术方式的手术时问、术中出血量、住院时间以及术后的复发情况。结果三种手术方式手术时间差异无显著性（P〉0．05）；鼻外入路组术中出血量及住院时间均大于鼻内镜入路组或者鼻内镜下联合柯一陆手术组（P〈0．05）。鼻外人路组术后复发率为29．4％，鼻内镜入路组复发率为25．9％，鼻内镜下联合柯一陆手术组复发率为25．0％，三组术后肿瘤复发率差异无显著性（P〉0．05）；随着肿瘤Krouse级别增加，复发率呈上升趋势。结论鼻内镜手术治疗KrouseI、Ⅱ级NIP损伤小，恢复快，对病变范围较大的Ⅲ期患者，鼻内镜下鼻内外联合人路是一种较好的选择。

Clinical analysis on effects of different surgical approaches in nasal inverted papilloma

Objective To evaluate the efficacy of different clinical criteria endoscopic surgical approach- es for inverted papillomas of the nasal cavity and paranasal sinus. Methods 60 cases diagnosed as nasal invert- ed papilloma （NIP） were retrospectively analyzed. Among these patients, 17 cases were treated by external ap- proach surgery, 27 cases by endoscopic surgery and 16 cases by endoscopy plus CaldweU-Luc approach resec- tion. Comparison was made in three groups in respects of operation time, blood loss, hospitalization time and re- covery. Results There were no obvious differences in operation time in three groups （P〉0.05）. The blood loss and hospital time in external approach group were significantly higher than those in endoscopic group or en- doscopy plus Caldwe11-Luc group（ P〈0.05 ）. There was no statistical significant difference in the recurrence rate in three groups （/x~0.05）. The recurrence rate was raised with the Krause stage increased. Conclusion For the cases of Krouse m, the external approach is a good supplementary for the surgery under nasal endoscope. By us- ing nasal endoscope united with external approach surgery, the tumor can be excised more thoroughly, with less residual and recurrence, and impairment can be cut down.