鼻内镜手术治疗鼻腔鼻窦内翻性乳头状瘤的临床效果观察

目的 探讨鼻内镜手术治疗鼻腔鼻窦内翻性乳头状瘤(SNIP)的临床效果.方法 回顾性分析93例行鼻内镜手术治疗的SNIP患者的临床资料,对患者进行Krouse分期,比较不同手术方法(单纯鼻内镜手术、鼻内镜联合改良柯-陆氏手术、鼻内镜联合鼻外进路手术)的治疗效果及术后复发情况.结果 所有患者均一次性完成手术,手术时间47~196 min,平均(94.3±25.9)min;术中出血量34~281 ml,平均(97.3±29.0)ml;术后随访时间26~62个月,平均(39.4±10.9)个月.19例KrouseⅠ期患者均采用单纯鼻内镜手术治疗,复发1例(5.26%).45例KrouseⅡ期患者中,32例采用单纯鼻内镜手术治疗,复发2例(6.25%);13例采用鼻内镜联合改良柯-陆氏手术治疗,复发1例(7.69%),两种手术方法的复发率比较,差异无统计学意义(P>0.05).25例KrouseⅢ期患者中,10例采用单纯鼻内镜手术治疗,复发6例(60.00%);15例采用鼻内镜联合改良柯-陆氏手术治疗,复发1例(6.67%),两种手术方法的复发率比较,差异有统计学意义(P<0.05).4例KrouseⅣ期患者均采用鼻内镜联合鼻外进路手术治疗,复发1例(25.00%).结论 鼻内镜手术治疗SNIP效果较好,复发率低,应根据患者肿瘤分期制定手术方案,并于术后定期复查以有效预防肿瘤复发.

Clinical observation of endoscopic surgery of sinonasal inverted papilloma

Objective To investigate the clinical effect of endoscopic surgery in the treatment of sinonasal inverted papilloma (SNIP). Method 93 cases of SNIP patients with different Krouse staging who were treated with nasal endo-scopic surgery were retrospectively analyzed, among patients treated with different surgeries (simple endoscopic surgery, endoscopic surgery combined with modified Caldwell-Luc procedure, endoscopic surgery with external approach), the clinical effect and postoperative recurrence were compared. Result All cases had successful procedures, with operative time of 47~196 min, average (94.3 ± 25.9) min, intraoperative blood loss was 34~281 ml, average (97.3 ± 29.0) ml, pa-tients were followed for 26~62 months, average (39.4 ± 10.9) months. 19 patients with Krouse stage I were treated with simple endoscopic surgery, and there was 1 case (5.26%) of recurrence. In 45 cases of Krouse stage II, 32 patients were treated with simple endoscopic surgery, and 2 had recurrence (6.25%);13 cases were given endoscopic surgery combined with modified Caldwell-Luc procedure, with 1 case (7.69%) of recurrence, and there was no statistically significant differ-ence observed between the two operation methods (P>0.05). Of the 25 cases of Krouse stage III, 10 had simple endoscop-ic surgery, and 6 (60.00%) had recurrence;15 were given combined Caldwell-Luc procedure, with 1 case (6.67%) of re-currence, and significant difference was observed (P<0.05). In patients at Krouse stage IV (4 cases), all were treated with nasal endoscopic surgery with external approach, in which 1 had recurrence (25.00%). Conclusion Nasal endoscopic surgery is effective in treating SNIP, with low recurrence rate, while surgical procedures should be established based on tumor stage, and regular follow up is required.