外科治疗鼻内翻性乳头状瘤100例临床分析

【目的】探讨鼻内翻性乳头状瘤单纯鼻内镜、鼻内镜辅助下的Caldwell—Luc手术和鼻侧切开术三种外科治疗方案的疗效及适应证。[方法]1999年1月至2006年3月收治鼻内翻性乳头状瘤患者100例，单纯鼻内镜治疗36例，鼻内镜辅助下Caldwell—Luc手术治疗35例，鼻侧切开术治疗29例，采用Krouse方法分级并统计术后复发率。【结果】术后平均随访3．2年，总复发率为20．0％，单纯鼻内镜Ⅰ级组9．1％，Ⅱ级组9．5％．Ⅲ级组50．0％；鼻内镜＋Caldwell—LUCⅡ级组为12．5％，Ⅲ级组12．5％，Ⅳ级组33．3％；鼻侧切开Ⅰ级组为0％，Ⅱ级组为50．0％，Ⅲ级组30％，Ⅳ级组40％。初次手术者72人，复发率19．4％，二次手术者28人，复发率为21．4％。【结论】Ⅰ，Ⅱ级鼻内翻性乳头状瘤病例推荐采用单纯鼻内镜治疗，Ⅲ级病例采用鼻内镜辅助下Caldwell—Luc手术治疗，Ⅳ级病例采用鼻侧切开术治疗，复发病例可以选择鼻内镜治疗。

Clinical Research on Surgical Therapy for Nasal Inverted Papilloma

[Objective]To discuss the therapeutic effect and indication of simple endoscope approach, endoscopic combined with Caldwell-luc and lateral rhinotomy approach for nasal inverted papolloma. [Methods]A retrospective analysis of 100 patients with nasal inverted papilloma was performed from March 2005 to March 2007. There are 36 cases operated on by simple endoscope approach, 35 by endoscopic combined with Caldwell-luc, and 29 by lateral rbinotomy approach. Every case was graded by Krouse method, and the recurrence rate of the three methods of different grades was calculated. [Results]The average follow-up time was 3. 2 years. The total recurrence rate was 20%. The recurrence rate for simple endoscope approach in grade Ⅰ , Ⅱand Ⅲwas 9.1%, 9.5% and 50%, respectively. The recurrence rate for endoscopic combined with Caldwellluc approach in grade Ⅱ , Ⅲand Ⅳwas 12.5%, 12.5% and 33.3%, respectively. The recurrence rate for lateral rhinotomy approach in grade Ⅰ . Ⅱ , Ⅲand Ⅳ was 0%, 50%, 30%and 40%, respectively. Seventytwo patients were for the first time to be operated on, and the recurrence rate was 19.4%. Twenty-eight patients were for the second time to be operated on, and the recurrence rate is 21.4 %. [Conclusion]The patients who are in grade Ⅰ or Ⅱshould be operated on by simple endoscope approach, grade Ⅲ by endoscopic combined with Caldwell-luc, grade Ⅳ by lateral rhinotomy approach and recurrence cases by endoscope approach.