鼻内窥镜在鼻腔鼻窦内翻性乳头状瘤切除术中的应用

目的　探讨和完善鼻内窥镜下彻底切除鼻内翻性乳头状瘤 ,降低术后复发率的手术方法及其适应证。方法　 1993年 2月至2 0 0 2年 6月住院的临床及病理诊断为鼻内翻性乳头状瘤 48例 ,其中 3 0例有 1～ 4次前期经鼻或鼻侧切开手术史。 3 7例患者采用鼻内窥镜经鼻肿瘤切除术 ;11例患者肿瘤侵及中鼻道、上颌窦口和部分或全部筛窦外 ,同时广泛侵及上颌窦内采用鼻内窥镜经鼻肿瘤切除 ,同时在内窥镜下经上颌窦前壁或下鼻道开窗联合径路肿瘤切除术 ,全部病例随访 10～ 3 6个月。结果　 48例中 1例术后复发 ,47例未复发 ,治愈率 97.9%。 8例 ( 16.7% )术后换药期间发现术腔局部出现瘤样组织 ,病理证实为内翻性乳头状瘤 ,内窥镜下以YAG激光处理局部创面 ,随诊 18个月 ,未再发现有瘤样组织。结论　辅以YAG激光治疗的内窥镜经鼻内翻性乳头状瘤切除术 ,有利于彻底切除肿瘤 ,该术式避免了面部疤痕 ,但对肿瘤已广泛侵及上颌窦内者宜采用联合径路术。

Application of an Endoscope in Surgery for the Treatment of Inverted Papilloma of Nasal Cavity and Paranasal Sinuses

Objective To study and perfect the endoscopic surgery for nasal inverted papilloma (Ip) and to decrease the recurrence after operation. Methods Forty-eight cases who were diagnosed as nasal Ip were divided into two groups according to the tumor extension and operated upon and observed for 10-36 months. 62.5%of all cases had been operated on for 1-4 times before the treatment. Thirty-seven cases had performed transnasal endoscopic surgical procedures (TNESP).Another group(11cases) in which involvement of the Ip had further extended into the maxillary sinus, had been treated by combination transnasal and Caldwell-Luc endoscopic surgical procedures (CTESP).Results 97.9% cases were not recurrent. The recurrence of the Ip was identified in 1 case (2.1%). But in 8 cases (16.7%), during postoperative follow-up management small masses of the Ip (pathologically identified)were observed and removed and irradiated with YAG laser immediately. The recurrence was not observed in the eighteen months follow-up period.Conclusion Endoscopic surgical technique combining the irradiation of YAG laser is recommended. This procedure was effective and lead to a decreased recurrence rate, the major advantage of which is to avoid an incision on the face.