内窥镜鼻内翻性乳头状瘤切除术  

Endoscopic surgery for nasal inverted papilloma

作　　者：于德林[1] 马有祥[1] 邢志敏[1] 

机构地区：[1]北京大学人民医院耳鼻咽喉科,100044

出　　处：《中华耳鼻咽喉科杂志》2001年第3期169-171,共3页Chinese Journal of Otorhinolaryngology

摘　　要：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　 1994年 1月～ 1999年 6月住院的临床及病理诊断为鼻内翻性乳头状瘤的患者47例 ,其中 2 4例有 1～ 3次前期经鼻或鼻侧切开术手术史。经CT、前鼻镜和内窥镜检查 ,肿瘤侵及中鼻道、上颌窦口和部分或全部筛窦者 2 9例 ,同时侵及蝶窦者 7例 ,2例肿瘤原发于鼻中隔 ,肿瘤侵及嗅裂下部、中鼻甲、中鼻道和部分筛窦 ;9例患者肿瘤除侵及中鼻道、上颌窦口和部分或全部筛窦外 ,同时广泛侵及上颌窦内。前者采用鼻内窥镜经鼻肿瘤切除术 ;后者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 (Caldwell Luc术式 )或下鼻道开窗联合径路肿瘤切除术。术前、中、后用电刀电凝肿瘤基部或以YAG激光光导纤维插入肿瘤根部和瘤体 ,术中应用吸切器 (shaversystem)切除瘤体 ,于肿瘤基部周围骨膜下剥离 ,局部骨骼化 ,注意将肿瘤及其基部粘骨膜一并切除。手术创腔痊愈后 1、3、6个月复查 ,以后随访。全部病例随访 12～ 40个月 (平均 2 4.6个月 )。结果　 47例中 2例术后复发 ,45例未复发 ,治愈率 95 .7%。 6例 (12 .7% )术后清理、换药期间发现术腔局部出现瘤样组织 ,病理检查证实内翻性乳头状瘤 ,内窥镜下去除并以电刀。Objective To study and perfect the endoscopic surgery for nasal inverted papilloma(IP) and to decrease the recurrence after operation. Methods Forty seven cases who were diagnosed as nasal IP were divided into two groups according to the tumor extension and operated upon and observed for 12～40 months(average 24.6 months). 51% of all cases had been operated on for 1～3 times before the treatment. Thirty six cases in which the tumor had invaded the lateral nasal wall, middle meatus, partial or total ethimoid and/or sphenoid and infiltrated around the natural ostium of the maxillary sinus had performed transnasal endoscopic surgical procedures(TNESP). Another group (9 cases) 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). In order to decrease bleeding during the operation, the body and bases of the IP were irradiated with YAG laser. The tumor was removed using the shaver system. The bony attachment of the IP and neighboring tissues were irradiated in all cases. Results Forty five (95.7%) cases were not recurrent. The recurrence of the IP was identified in two cases (4.3%). But in 6 cases (12.8%), during postoperative follow up management (1～3 months postoperatively) small mass of the IP (pathologically identified) were observed and removed and irradiated with YAG laser immediately. The recurrence was not observed in the one year follow up period. Conclusion Endoscopic surgical technique combining the irradiation of YAG laser and the application of shaver system is recommended. This procedure was effective and led to a decreased recurrence rate.

关 键 词：内窥镜 乳头状瘤 鼻窦 耳鼻喉外科手术方法 

分 类 号：R739.62[医药卫生—肿瘤]