山东大学耳鼻喉眼学报 ›› 2008, Vol. 22 ›› Issue (6): 511-514.

• 论文 • 上一篇    下一篇

鼻腔鼻窦内翻性乳头状瘤手术入路的选择及疗效

王学海,李学忠,蔡晓岚,张立强,徐豪杰,陈成芳,韩学锋   

  1. 1. 山东大学齐鲁医院耳鼻咽喉-头颈外科, 济南 250012; 2. 山东省中医药大学第二附属医院, 济南 250001
  • 收稿日期:2008-08-30 修回日期:2008-10-16 出版日期:2008-12-16 发布日期:2008-12-16
  • 通讯作者: 李学忠(1964- ),男,医学博士,主任医师,教授,科副主任,主要从事鼻科学的基础与临床研究工作。
  • 作者简介:王学海(1982- ),男,硕士研究生,主要从事鼻科学的研究工作。Email:xuehai581@163.com

Choice and effect of surgical treatment for sinonasal inverted papilloma

 WANG Xue-Hai, LI Xue-Zhong, CAI Xiao-Lan, ZHANG Li-Qiang, XU Hao-Jie, CHEN Cheng-Fang, HAN Xue-Feng   

  1. 1. Department of Otorhinolaryngology and Head & Neck Surgery, Qilu Hospital of Shandong University, Jinan 250012,  China; 2. Department of Otolaryngology, Second Affiliated Hospital of Shandong University ofTraditional Chinese Medicine, Jinan 250001,  China
  • Received:2008-08-30 Revised:2008-10-16 Online:2008-12-16 Published:2008-12-16

摘要:

目的以鼻窦冠状位CT扫描及鼻内镜检查为依据,对鼻腔鼻窦内翻性乳头状瘤(sinonasal inverted papilloma, NIP)进行Krouse分级,探讨单纯鼻内镜手术、鼻内镜下鼻内外联合入路与传统手术方式治疗的差异。方法对3种不同入路手术治疗的124例NIP患者的临床资料进行回顾性分析,比较不同手术方式的临床参数(手术时间、术中出血量、住院时间)的差异并随访观察术后的临床疗效。 结果鼻内镜下鼻内外联合入路组与鼻外入路组差异有统计学意义(P<0.05);对于Krouse Ⅰ级和Ⅱ级的病例,鼻内镜组复发率明显低于鼻外入路组(P<0.05);对于Krouse Ⅲ级的病例,鼻内镜下鼻内外联合入路组的复发率也低于其他两组(P<0.05),而鼻内镜组与鼻外入路组的复发率差异无统计学意义。鼻内镜手术组住院时间短,术中出血量明显少于其他两组,差异有统计学意义(P<0.05),而各组间手术时间长短差异无统计学意义。 结论鼻内镜手术治疗Krouse Ⅰ级、Ⅱ级NIP安全、经济、有效,对病变范围广泛和多次手术复发的Ⅲ期、Ⅳ期患者, 鼻内镜下鼻内外联合入路是一种较好的选择, 值得在临床实践中进一步探讨。

关键词: 乳头状瘤,内翻性; 内窥镜检查; 外科手术

Abstract:

To evaluate the effects and difference of endoscopic surgery , endoscopic surgery combined with an external approach and traditional procedures in the treatment of sinonasal inverted papilloma(NIP). MethodsOne hundred and twentyfour patients with NIP treated by the three surgical approaches were retrospectively reviewed.Parameters for comparison included operative time, estimated blood loss during operation and length of admission. ResultsThere were significant differences between the group of endoscopic surgery combined with an external approach and the group of traditional procedure(P<0.05). In the Krouse Ⅰ and Ⅱ cases, recurrence was lower in the endoscopic surgery group than that in  the traditional procedure group(P<0.05). In the Krouse Ⅲ cases,  recurrence was lower in the endoscopic surgery combined with an external approach group than that in the other two groups(P<0.05), but there was no difference between the endoscopic surgery and traditional procedure groups. Average operation time was similar in the three groups, the average estimated blood loss during the operations and length of admission time were statistically shorter in the  endoscopic group than those in the other two groups(P<0.05). ConclusionsEndoscopic surgery is a safe,economical and effective method for the NIP cases in Krouse Ⅰ and Ⅱ. For the Krouse Ⅲ or/and Ⅳ cases with recurrence or extensive disease, endoscopic surgery combined with an external approach is a better choice which should be studied in clinical practice.

Key words: Papilloma, inverted;  Endoscopy;  Surgical procedures, operative

中图分类号: 

  • R739.65
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