鼻内镜手术在鼻内翻性乳头状瘤治疗中的临床价值

发布时间：2018-10-16 21:40

【摘要】：目的和背景 鼻内翻性乳头状瘤(nasal inverted papilloma, NIP)是鼻腔和鼻窦粘膜常见的良性肿瘤,其临床特点是易复发、可破坏周围骨质及正常的解剖结构和有恶变为鳞状细胞癌的倾向,故NIP首选的治疗方式一直是外科手术,其手术治疗原则是根治性切除肿瘤。手术关键在于：一是彻底清除肿瘤及其累及的鼻腔鼻窦组织；二是彻底切除肿瘤基底部及其邻近的粘膜和骨质。本病传统术式为鼻外进路,但其创伤大、面部遗留疤痕,尤其是对鼻腔鼻窦的功能性保护不够。大量临床资料证实鼻外径路与鼻内镜下手术的治疗效果并无显著性差异。近年来随着鼻内镜微创技术的发展和成熟,应用精细的手术解剖技术处理病变也逐渐成熟,患者也更容易接受。 本文通过临床上较常见的三种术式：单纯鼻内镜手术、鼻内镜辅助下的Caldwell-Luc手术和鼻侧切开术治疗鼻腔鼻窦内翻性乳头状瘤,对术后复发率进行统计分析,探讨鼻内镜手术在鼻内翻性乳头状瘤治疗中的临床价值。 方法 1临床病例资料：本文选取郑州大学第一附属医院2005年6月～2010年6月的43例住院NIP患者,所有病例随访资料完整。 2手术方式及分级方法：通过病例的登记表进行回顾性分析,手术方式采用单纯鼻内镜手术、鼻内镜辅助下的Caldwell-Luc手术或鼻侧切开术,其中接受单纯鼻内镜手术治疗的病例18例,接受鼻内镜辅助下Caldwell-Luc手术方法治疗的病例15例,接受鼻侧切手术方法治疗的病例10例。对其术后复发情况进行跟踪随访,对于每个病例采用Krouse方法分级,且分别对相同级别三种手术方法的复发率进行列表计算,术后平均随访1.7年。 3统计学分析：应用SPSS17.0统计软件进行计算分析,采用卡方检验(X检验),检验标准：α=0.05。 结果 总复发率为9.3%。单纯鼻内镜手术Ⅰ级组复发率为11.1%,Ⅲ级组复发率为33.3%,鼻侧切术Ⅲ级组复发率为25.0%,Ⅳ级组复发率为33.3%。临床分期相同的病患采用三种术式的疗效无明显差异。一次手术治愈者37例,术后复发行二次手术者4例,二次术后无再次复发。 结论 1鼻内窥镜下手术是治疗Ⅰ～Ⅱ级鼻内翻性乳头状瘤一种较好的方法,对于病变主要侵及窦口鼻道复合体、后组筛窦及蝶窦的Ⅲ级病例行鼻内镜下鼻窦手术也可有良好效果。其主要优点是视野清晰、避免了面部切口、术后较少阻塞泪道及较好的保留局部结构和鼻腔鼻窦粘膜功能。 2对累及上颌窦内、外侧壁和底壁的Ⅲ级病例联合柯-陆进路手术可取得较好疗效,对Ⅳ级病例采用鼻侧切为首选,鼻内镜术中可有辅助作用。 3鼻内窥镜手术治疗复发病例、双侧发病病例仍有较好效果。 4鼻内窥镜对NIP的术前检查及术后复查都具有明显的优势,可早期发现病变,术后及时清除复发病变。
[Abstract]:Objective and background nasal inverted papilloma (nasal inverted papilloma, NIP) is a common benign tumor in nasal cavity and nasal sinus mucosa. Its clinical characteristics are that it can easily recur, can destroy the surrounding bone and normal anatomical structure, and has the tendency of malignant transformation into squamous cell carcinoma. Therefore, the first choice of treatment for NIP has been surgery, the principle of surgical treatment is radical resection of tumor. The key points of the operation are as follows: first, the tumor and its involved nasal and paranasal sinuses should be completely removed; second, the base of the tumor and its adjacent mucous membrane and bone should be completely removed. The traditional operation of this disease is external nasal approach, but its trauma, facial scars, especially the functional protection of nasal sinuses is not enough. A great deal of clinical data confirmed that there was no significant difference in the treatment effect between external nasal approach and endoscopic sinus surgery. In recent years, with the development and maturity of endoscopic minimally invasive techniques, the use of fine surgical anatomy techniques to deal with lesions is gradually mature, patients are also more easily accepted. In this paper, we analyzed the recurrence rate of inverted papilloma of nasal cavity and paranasal sinuses by three common methods: simple endoscopic surgery, endoscopic Caldwell-Luc operation and lateral nasal incision. To investigate the clinical value of endoscopic sinus surgery in the treatment of nasal inverted papilloma. Methods 1 Clinical data: 43 patients with NIP were selected from the first affiliated Hospital of Zhengzhou University from June 2005 to June 2010. All cases were followed-up with complete data. 2 methods of operation and classification: retrospective analysis was made through the registration form of the cases. The operation was performed by simple endoscopic surgery, endoscopic Caldwell-Luc operation or lateral nasal incision. Among them, 18 cases were treated by simple endoscopic surgery, 15 cases were treated by Caldwell-Luc method, and 10 cases were treated by nasal lateral resection. The recurrence rate was followed up, each case was classified by Krouse method, and the recurrence rate of three surgical methods of the same grade was calculated. The average follow-up was 1.7 years. 3 Statistical analysis: the statistical software of SPSS17.0 was used to calculate and analyze. The chi-square test (X test) was used. The test standard was 伪 = 0.05. Results the total recurrence rate was 9.3%. The recurrence rate of grade 鈪，

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