鼻内翻性乳头状瘤kamel分期对术式选择的意义

目的 研究以鼻内翻性乳头状瘤(NIP)起源为主要依据的临床分期，用以指导手术和评价术后疗效。方法 回顾性分析55例NIP手术病例。男37例，女18例，男女比例为2∶1，27~78岁。右侧23例，左侧32例，未发现双侧发病者。11例有NIP手术史。25例术前病理检查证实为NIP，按照kamel分期，其中Ⅰ型30例、Ⅱ型25例。 结果 Ⅰ型NIP行鼻内镜下局部切除术(30例)，Ⅱ型NIP行鼻内镜下局部切除术(4例)、鼻内镜下上颌窦内侧壁切除术(11例)、鼻内镜下双径路手术(10例)。复发率：Ⅰ型复发率为6.7％(2/30)，Ⅱ型复发率为16.0％(4/25)，总复发率为10.9％(6/55)。和检索资料相比复发率差异无统计学意义。结论 NIPⅠ型手术采取鼻内窥镜下局部切除术，Ⅱ型采取鼻内镜下上颌窦内壁切除术或经唇龈沟切口上颌窦前壁开窗结合经鼻内镜手术(双径路手术)。术后复发率和报道资料复发率相比没有统计学意义，说明这种基于疾病来源新的Kamel方法临床分型对手术治疗有指导意义，并且经鼻内镜鼻内翻性乳头状瘤切除和传统方法相比有较大优势。

Effect of the Kamel classification system of nasal inverted papilloma on operative approach

Objective To investigate the clinical classification of NIP and to show how to use this classification in planning surgery and evaluating results. Method a retrospective study with fifty cases of NIP patients. The lesions were classified into type I (30 cases), originating from the nasal septum or lateral nasal wall (LNW), and type II (25 cases), originating from the maxillary sinus. Results We performed with conservative transnasal endoscopic excision (30 cases) in Type I and with performed conservative transnasal endoscopic excision (4 cases), radical transnasal endoscopic medial maxillectomy (11 cases), combined approach (10 cases). In Type I recurrence was 6.7％(2/30).and 16.0％(4/25) in Type Ⅱ, 10.9％(6/55) in all cases. The recurrence of all cases were compared to the reported, The difference was not statistically significant. Conclusion We performed with conservative transnasal endoscopic excision in Type I and with performed radical transnasal endoscopic medial maxillectomy and combined approach in Type Ⅱ. The difference was not statistically significant in the recurrence when compared to the reported. So, it proves that this Kamel′s classification has a role in planning surgery and evaluating results, and transnasal endoscopic excision of NIP is a good choice.