低温等离子手术治疗上颌窦鼻内翻性乳头状瘤效果及复发的影响因素  

The effect of low-temperature plasma therapy on the treatment of inverted papilloma of the maxillary sinus and the influencing factors of recurrence

作　　者：周荣金[1] ZHOU Rong-jin(Department of Ear Nose and Throat,People′s Hospital of Dongtai City,Jiangsu Province,Dongtai 224200,China)

机构地区：[1]江苏省东台市人民医院耳鼻喉科,江苏东台224200

出　　处：《河北医科大学学报》2024年第7期761-765,共5页Journal of Hebei Medical University

基　　金：江苏省优势学科建设工程项目(SHL0816-76)。

摘　　要：目的 探讨低温等离子手术治疗上颌窦鼻内翻性乳头状瘤效果及复发的影响因素。方法 选取上颌窦鼻内翻性乳头状瘤患者331例,均行低温等离子手术。统计手术效果、复发情况,比较复发组(n=48)和未复发组(n=273)的临床资料,采用多因素分析复发的影响因素,评价Logistic回归模型对复发预测价值,并进行个体值验证。结果 331例上颌窦鼻内翻性乳头状瘤患者均行低温等离子手术,治疗总有效率为85.80%(284/331),并发症总发生率为4.83%(16/331),复发率为14.95%(48/321)。复发组血管内皮生长因子(vascular endothelial growth factor, VEGF)水平、人乳头瘤病毒感染、Krouse分级级别、不典型增生程度、鼻部手术史、核分裂象数高于未复发组,差异有统计学意义(P<0.05)。Logistic多因素分析结果显示,VEGF水平升高(OR=9.167,95%CI:4.456~18.857)、Krouse分级Ⅲ级(OR=7.280,95%CI:2.267~23.381)、明显不典型增生(OR=10.608,95%CI:5.611~20.054)、核分裂象数>10(OR=8.121,95%CI:3.762~17.531)是上颌窦鼻内翻性乳头状瘤患者术后复发的独立危险因素(P<0.05)。Logistic回归模型对复发预测价值分析显示,以4.30为最佳临界值,AUC为0.919,95%CI:0.884~0.947。个体验证显示,在预测准确率为89.72%的条件下,该患者无复发风险,且符合临床实际。结论 低温等离子手术应用于上颌窦鼻内翻性乳头状瘤疗效显著,但其术后复发受VEGF水平、Krouse分级、不典型增生、核分裂象数等多种因素影响,综合考虑以上因素并积极干预,有利于预防复发。Objective To investigate the effect of low-temperature plasma therapy on the treatment of inverted papilloma of the maxillary sinus and the influencing factors of recurrence.Methods A total of 331 patients with inverted papilloma of the maxillary sinus were selected and underwent low-temperature plasma surgery.The surgical effects and recurrence were statistically analyzed.The clinical data of the recurrence group(n=48)and non-recurrence group(n=273)were compared,and the factors affecting recurrence were analyzed using multivariate analysis.The Logistic regression model was evaluated for its predictive value for recurrence,and individual values were verified.Results The total effective rate of 331 patients with inverted papilloma of the maxillary sinus undergoing low-temperature plasma surgery was 85.80%(284/331),the total complication rate was 4.83%(16/331),and the recurrence rate was 14.95%(48/321).The levels of vascular endothelial growth factor(VEGF),human papillomavirus infection,Krouse classification,degree of atypical hyperplasia,history of nasal surgery,and number of mitotic figures in the recurrence group were higher than those in the non-recurrence group,and the difference were statistically significant(P<0.05).The results of Logistic multivariate analysis showed that increased VEGF levels(OR=9.167,95%CI:4.456-18.857),Krouse gradeⅢ(OR=7.280,95%CI:2.267-23.381),obvious atypical hyperplasia(OR=10.608,95%CI:5.611-20.054),and mitotic figures>10(OR=8.121,95%CI:3.762-17.531)were independent risk factors for recurrence in patients with inverted papilloma of the maxillary sinus after surgery(P<0.05).The Logistic regression model analysis of the predictive value for recurrence showed that the optimal critical value was 4.30,with an AUC of 0.919 and a 95%CI of 0.884-0.947.Verification by individual patients showed that under the condition of an accuracy rate of 89.72%,the patient had no risk of recurrence and was in line with clinical reality.Conclusion The application of low-temperature plasma surgery in the t

关 键 词：上颌窦肿瘤 冷冻电子显微镜检查 复发 

分 类 号：R739.62[医药卫生—肿瘤]