鼻内翻性乳头状瘤的临床诊疗分析  

Analysis of clinical diagnosis and treatment of nasal inverted papilloma

作　　者：李峰 徐明锋 刘晓瑜 麦颖达 潘文芳 章诗富 崔德威 许卫华 LI Feng;XU Mingfeng;LIU Xiaoyu;MAI Yingda;PAN Wenfang;ZHANG Shifu;CUI Dewei;XU Weihua(Otolaryngology,Head and Neck Surgery Department,Affiliated Hospital of Guangdong Medical University,Zhanjiang 524001,China)

机构地区：[1]广东医科大学附属医院耳鼻咽喉头颈外科,广东湛江524001

出　　处：《临床医学研究与实践》2022年第20期27-31,共5页Clinical Research and Practice

基　　金：广东省社会发展项目(No.21101k01101);2020年度湛江市科技发展专项资金竞争性分配项目(No.200904164541248)。

摘　　要：目的总结现有的关于鼻内翻性乳头状瘤(NIP)的研究结论,对其诊疗过程进行分析,旨在减少NIP的漏诊以及降低其术后复发率。方法回顾性分析广东医科大学附属医院耳鼻咽喉头颈外科2014年7月至2019年2月收治并经病理诊断确诊的32例NIP患者的临床资料,其中男23例,女9例,年龄29~82岁。术前均完善鼻内镜、鼻窦CT增强扫描,部分患者另行磁共振增强扫描及血清鳞状细胞癌抗原(SCCA)检查。部分患者术前经病理检查确诊,部分患者术中送冰冻病理确诊,部分患者术后经常规病理检查确诊,32例患者均行鼻内镜手术切除。患者术后半年内1周、2周及每月复查1次,半年后每3个月复查1次,并逐渐延长随访周期,但延长不超过半年。如内镜下发现异常,及时清理并进行病理活检。结果出院后随访发现3例未行冰冻病理者术后复查见新生物,活检确诊为复发。其余术前诊断明确者中也有2例在随访中明确复发。结论NIP可能与鼻息肉并存,多生发中心起源不少见。术前需结合鼻内镜、鼻窦CT增强扫描、磁共振增强扫描及SCCA检查,术中予以冰冻病理以提高结束手术前的确诊率。术中结合多种手术入路以确保彻底切除肿瘤根蒂部及所有生发中心,嘱患者术后定期随诊及戒烟,尽可能降低术后复发率。Objective To summarize the existing research conclusions on nasal inverted papilloma(NIP)and analyze its diagnosis and treatment process to reduce missed diagnosis and postoperative recurrence rate of NIP.Methods The clinical data of 32 patients with NIP admitted in the otorhinolaryngology,head and neck surgery department of Affiliated Hospital of Guangdong Medical University from July 2014 to February 2019 and diagnosed by pathology were retrospectively analyzed.Among them,there were 23 males and 9 females,aged 29-82 years old.Before operation,nasal endoscopy and CT enhanced scanning of paranasal sinuses were improved,and some patients underwent enhanced magnetic resonance scanning and serum squamous cell carcinoma antigen(SCCA)examination.Some patients were confirmed by pathological examination before operation,some patients were confirmed by frozen pathology during operation,and some patients were confirmed by routine pathological examination after operation.All 32 patients underwent endoscopic surgery.The patients were reexamined once a week,twice a week and once a month within half a year after operation,and reexamined once every three months after half a year,and the follow-up period was gradually extended,but not more than half a year.If any abnormality was found under endoscopy,it should be cleared up in time and pathological biopsy should be performed.Results In the follow-up after discharge,it was found that 3 cases without frozen pathology had new organisms in postoperative reexamination,and recurrence was confirmed by biopsy.Among the other cases with definite preoperative diagnosis,2 cases had definite recurrence during follow-up.Conclusion NIP may coexist with nasal polyps,and multiple germinal centers is not uncommon.Nasal endoscopy,CT enhanced scanning,enhanced magnetic resonance scanning of nasal sinuses and SCCA examination should be combined before operation.Frozen pathology should be performed during operation to improve the diagnostic rate before the end of operation.Various surgical approach

关 键 词：鼻内翻性乳头状瘤 骨质侵蚀 多生发中心 鳞状细胞癌抗原 

分 类 号：R739.62[医药卫生—肿瘤]