CAJ | 학술논문

目的探讨和完善鼻内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适应症.方法总结1999年1月-2008年12月确诊为鼻内翻性乳头状瘤的患者,按Krouse 分期均为Ⅱ～Ⅲ级病例,治疗组39例,其中7例(17.9%)既往有1～2次鼻部手术史.术中先泪道置管,并应用动力系统切除瘤体,切除上颌窦内壁大部,30°镜下将肿瘤于肿瘤基底部周围骨膜下剥离,局部骨骼化,基底部残余软组织用电刀将其烧灼以防止复发.对照组21例,采用Caldwell-Luc术式或鼻侧切开术治疗.术后每周复查至术腔上皮化,此后长期随访.结果所有患者均在鼻内镜下随访,治疗组39例患者中,1例于术后4月复查时发现后组筛窦内复发,予咬除肿物后以电刀烧灼后随访至今未见复发(随访已超过3年).其余38例经随访1～9年,未见复发,治愈率97.4%.对照组21例中5例复发两组复发率比较差异有显著性(P<0.05).结论在正确选择适应证的前提下,泪道置管联合鼻内镜下上颌窦内壁扩大切除术治疗鼻内翻性乳头状瘤具有微创、避免面部瘢痕、手术时间短、出血少、便于术后复查、手术在同一术野进行等优点,有利于肿瘤的彻底切除.
목적 탐토화완선비내경하철저절제비내번성유두상류、강저술후복발솔적수술방법급괄응증.방법 총결1999년1월-2008년12월학진위비내번성유두상류적환자,안Krouse 분기균위Ⅱ～Ⅲ급병례,치료조39례,기중7례(17.9%)기왕유1～2차비부수술사.술중선루도치관,병응용동력계통절제류체,절제상합두내벽대부,30°경하장종류우종류기저부주위골막하박리,국부골격화,기저부잔여연조직용전도장기소작이방지복발.대조조21례,채용Caldwell-Luc술식혹비측절개술치료.술후매주복사지술강상피화,차후장기수방.결과 소유환자균재비내경하수방,치료조39례환자중,1례우술후4월복사시발현후조사두내복발,여교제종물후이전도소작후수방지금미견복발(수방이초과3년).기여38례경수방1～9년,미견복발,치유솔97.4%.대조조21례중5례복발량조복발솔비교차이유현저성(P<0.05).결론재정학선택괄응증적전제하,루도치관연합비내경하상합두내벽확대절제술치료비내번성유두상류구유미창、피면면부반흔、수술시간단、출혈소、편우술후복사、수술재동일술야진행등우점,유리우종류적철저절제.
Objective To explore endoscopic resection of nasal inverted papilloma (NIP) and the surgical procedure for reducing postoperative recurrence and its indications. Methods 39 patients who had been diagnosed as stage Ⅱ -Ⅲ NIP during January 1996 to December 2008 were assigned to the study group, 7 of whom (17.9%) had a history of nasal surgery. Aftera tube was implanted into the lacrimal duct, the tumor was removed using the Xps3000 and most of the inner wall of maxillary sinus was resected. The bony attachment of the tumor and the neighboring tissues were resected and the residual soft tissues were cauterized to prevent relapse. 21 patients received Caldwell-Luc precedure or paranasal incision in the control group. Results All the patients were followed up with transnasal endoscopy. One of 39 patients in the study developed recurrence in the posterior ethmoid sinus.But after the small mass of recurrence was removed and cauterized, recurrence disappeared more than 3 year. No relapse was found in the rest 38 patients during a follow-up of 1 to 9 years, with a curative rate of 97.4%. 5 of 21 patients occurred in the control group. Conclusions Under the condition of proper selection of candidates, lacrimal tube implantation plus extended transnasal endoscopic resection of the inner wall of maxillary sinus for nasal inverted papilloma is less invasive, preventing the formation of facial scars, and it has shorter surgical duration and less bleeding.