鼻内翻性乳头状瘤恶变的内镜或内镜辅助下手术  

Endoscopic surgery and endoscopy-assisted surgery for the malignant transformation of sinonasal inverted papilloma

作　　者：孙伟元[1] 赵娜[1] 翟瑞华[1] 马智军[1] 

机构地区：[1]山东省潍坊市益都中心医院耳鼻咽喉头颈外科,262500

出　　处：《中华耳鼻咽喉头颈外科杂志》2011年第12期1036-1039,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的 探讨鼻内镜下或内镜辅助下鼻内翻性乳头状瘤（sinonasal inverted papilloma,Sip）恶变的手术方法,并对其预后及影响因素进行分析.方法 对2001年2月至2010年12月山东省潍坊市益都中心医院耳鼻咽喉头颈外科收治的7例SIP恶变者于鼻内镜下或内镜辅助下手术且术后时间达3年以上者的临床资料进行回顾性分析.7例患者均单侧发病,左侧2例,右侧5例,病程1～10年,中位数3年.术前均行鼻窦CT扫描,按SIP的Krouse分级标准均达Ⅳ级；T2期1例,T3期5例,T4期1例.手术在全麻或局麻＋强化麻醉下进行.术中注意结合术前CT扫描于鼻内镜下确定肿瘤安全缘.术后行放射治疗,剂量60～ 70 Gy.结果 所有病例均经病理证实恶变为鳞癌.术后均出现患侧鼻腔干燥,1例泪道受侵者术后长期泪溢.患者术后随访时间均满3年,其中5年以上者3例.术后3年内复发者3例,其中2例为术后1年内局灶性复发,另1例系术后未行放疗者.结论 SIP恶变病例内镜或内镜辅助下手术微创、彻底、并发症少,术后鼻功能恢复良好；术后宜辅以放射治疗,可获得较满意的中、长期疗效.Objective To investigate malignant transformation of sinonasal inverted papilloma（SIP）treated by nasal endoscopic and endoscopy-assisted surgery.Methods Seven cases with malignant transformation of SIP treated by nasal endoscopic and endoscopy-assisted surgery from February 2001 to December 2010 were reviwed.Followed-up time after surgery for each case was over 3 years.All cases were unilateral disease and at grade Ⅳ according to the SIP grading standards of Krouse.One case was T2,five T3,and one T4.The surgery were performed under general anaesthesia or local and strengthen anaesthesia.Postoperative radiotherapy was applided,with the doses of 60-70 GY.Results All cases were squamous cell carcinoma confirmed pathologically after surgery.The patients were followed up with endoscopic examination for 3-5 years.Of 7 cases,recurrent disease occurred in 3 years after operation,but no recurrece in other 4 cases.Conclusions Nasal endoscopic and endoscopy-assisted surgery can be used in the treatment for the malignant transformation of SIP,with the advantages of minimally invasion,fewer complications and the well-preserved nasal functions.Application of radiotherapy after surgery could improve long-term survival efficacy of the patients.

关 键 词：乳头状瘤 内翻 内窥镜检查 鼻窦肿瘤 放射疗法 

分 类 号：R739.62[医药卫生—肿瘤]