影响鼻腔鼻窦内翻性乳头状瘤复发的相关因素分析  

Analysis of the recurrence related factors of sinonasal inverted papilloma

作　　者：王茂华 关兵[2] 于爱民[2] 戴炳译 严齐 陈思思 

机构地区：[1]中南大学湘雅二医院耳鼻咽喉头颈外科,长沙410000 [2]江苏省苏北人民医院耳鼻咽喉头颈外科

出　　处：《临床耳鼻咽喉头颈外科杂志》2017年第24期1927-1930,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨影响鼻腔鼻窦内翻性乳头状瘤(SNIP)复发的危险因素及减少复发的方法。方法:回顾性分析34例SNIP患者的临床资料。均为单侧发病,按Krouse分级方法进行临床分级。均在鼻内镜下手术治疗,其中单纯鼻内镜下肿瘤切除术20例,鼻内镜下联合泪前隐窝入路手术14例。术后随访12~36个月,统计患者复发情况并分析复发的影响因素。结果:34例SNIP患者术后总复发率为17.65%(6/34);单纯鼻内镜下肿瘤切除术复发率25.00%(5/20),鼻内镜下联合泪前隐窝入路手术复发率7.14%(1/14),两者比较差异无统计学意义(χ~2=1.807,P>0.05)。Ⅰ、Ⅱ、Ⅲ、Ⅳ级复发率分别为0(0/4)、15.0%(3/20)、33.3%(3/9)和0(0/1),不同分级患者比较,差异无统计学意义(χ~2=2.692,P>0.05)。结论:单纯鼻内镜下肿瘤切除术和鼻内镜下联合泪前隐窝入路手术均为治疗SNIP的有效方法。鼻部手术史及肿瘤生发中心是影响患者复发的危险因素。术前进行详细检查、术中彻底切除肿瘤、术后定期内镜检查是减少复发的关键。Objective：To evaluate the influence risk factors of recurrence and the methods for reducing recurrence of sinonasal inverted papilloma（SNIP）.Method：Clinical data of 34 patients with SNIP were analyzed retrospectively.All of them were unilateral onset.The diagnosis was confirmed pathologically and the range of lesions was determined by endoscopic and imaging examination;clinical classification according to Krouse classification method;All operations were performed under nasal endoscope,of which 20 cases were operated by simple nasal endoscope,and 14 cases were operated by endoscopic anterior lacrimal recess approach.The patients were followed up for 12-36 months.The curative effects were observed and the prognostic factors of the patients were analyzed.Result：Thirty-four cases of SNIP patients with postoperative recurrence rate was 17.65%（6/34）;simple nasal endoscopic surgery in 20 cases,the recurrence rate was 25.00%（5/20）;endoscopic anterior lacrimal recess approach in 14 cases,the recurrence rate was 7.14%（1/14）,the difference was statistically insignificant（χ~2=1.807,P0.05）.Four cases in stage Ⅰ had no recurrence;20 cases in stage Ⅱ,the recurrence rate was15.0%（3/20）;9 cases in stageⅢ,the recurrence rate was 33.3%（3/9）;1 case in stageⅣ had no recurrence,the recurrence rate of the patients with different stages were statistically insignificant（χ~2=2.692,P0.05）.Conclusion：Simple endoscopic resection of the tumor and endoscopic anterior lacrimal recess surgery are effective methods for the treatment of SNIP.The nasal surgery history and tumor origin are the risk factors for recurrence.The operation completely tumorresection,detailed preoperative examination and postoperative regular endoscopic examination are the keys to preventing recurrence.

关 键 词：鼻腔鼻窦内翻性乳头状瘤 内镜外科手术 复发 预后 

分 类 号：R739.62[医药卫生—肿瘤]