鼻内镜手术治疗鼻腔鼻窦内翻性乳头瘤的预后相关因素分析  

Clinical factors related to recurrence of sinonasal inverted papilloma after endoscopic surgery

作　　者：李振安[1] 何清泉[1] 吴新一 李赣 

机构地区：[1]广东佛山市妇幼保健院耳鼻咽喉科,528000 [2]广东佛山市顺德区第一人民医院耳鼻咽喉科

出　　处：《中国中西医结合耳鼻咽喉科杂志》2015年第5期340-343,共4页Chinese Journal of Otorhinolaryngology in Integrative Medicine

摘　　要：目的分析鼻腔鼻窦内翻性乳头瘤(NIP)鼻内镜手术后影响复发的临床因素,为预后评价提供依据。方法回顾性分析2002-2011年我院收治的NIP患者的临床资料,比较不同性别、手术方式、Krouse分期和病变部位的患者术后复发率的差异,采用生存分析的方法分析临床因素对患者术后无复发生存时间的影响。结果 39例NIP患者男27例,女12例,年龄26-85岁。38例(97.4%)出现鼻塞,32例(82.1%)涕中带血,29例(74.4%)有浓涕,15例(38.5%)头痛,13例(33.3%)嗅觉减退。12例(30.8%)病变局限于鼻腔、鼻道,2例病变在鼻中隔,16例(41.0%)累及上颌窦,10例(25.6%)累及筛窦,1例累及蝶窦。术后总体复发率17.9%(7/39),复发时间18-90月。性别、单纯鼻内镜手术或联合Caldwell-Luc术、病变位于左或右侧和Krouse分期对复发率无显著影响,但筛窦受累的患者术后复发率更高(P=0.01)。Cox回归分析示Krouse分期对患者无复发生存时间有影响(P=0.02)。结论筛窦受累的NIP患者鼻内镜手术后复发率更高,Krouse分期对复发的早晚有一定预测价值。Objective To study the correlations between clinical characteristics and recurrence rates of sinonasal inverted papilloma （NIP） after endoscopic surgery, and to explore potential prognostic factors. Methods A retrospective study was designed to analyze clinical characteristics of NIP patients treated in our hospital in 2002-2011. Recurrence rates of different gender , surgery approaches, Krouse staging and loci were compared by using Fisher＇s exact test. Moreover, recurrence-free survival of patients with different clinical features was analyzed by using the log-rank test and Cox-regression analysis. Results A total of 39 patients （male/ female=27/12）, aged 26-85 years, underwent endoscopic surgery alone or combined with Caldwell-Luc approach, were followed up for 1-10 years. Thirty-eight （97.4%） of these patients presented unilateral nasal obstruction, 32 （82.1%） patients presented blood mixed nasal discharge, 29 （74.4%） patients had yellow nasal discharge, 15 （38.5%） patients got headache and 13 （33.3%） patients had decreased or loss of smell. Neoplasm was located in nasal cavity or tract （12/39）, on septum （2/39）, with invading maxillary sinus （16/ 39）, ethmoid sinus （10/39） and sphenoid sinus （1/39）. Seven （17.9%） of these patients showed postoperative recurrence after 18-90 months. Patients with papilloma invading ethmoid sinus had higher recurrence rate （P=0.01）, but gender, surgery approaches, sides of loci and Krouse staging did not show a significant correlation with recurrence rates. However, significant difference of recurrence-free survival was found among patients with different Krouse staging by using Cox regression analysis （P=0.02）. Conclusion Patients with inverted papilloma invading ethmoid sinus may be more likely to relapse after endoscopic surgery and Krouse staging may be a prognostic factor to predict early or late onset of recurrence.

关 键 词：鼻腔肿瘤 内翻性乳头瘤 鼻内镜手术 复发 

分 类 号：R739.62[医药卫生—肿瘤]