鼻內(nèi)鏡手術在鼻內(nèi)翻性乳頭狀瘤治療中的臨床價值
發(fā)布時間：2018-10-16 21:40
【摘要】：目的和背景 鼻內(nèi)翻性乳頭狀瘤(nasal inverted papilloma, NIP)是鼻腔和鼻竇粘膜常見的良性腫瘤,其臨床特點是易復發(fā)、可破壞周圍骨質(zhì)及正常的解剖結(jié)構(gòu)和有惡變?yōu)轺[狀細胞癌的傾向,故NIP首選的治療方式一直是外科手術,其手術治療原則是根治性切除腫瘤。手術關鍵在于：一是徹底清除腫瘤及其累及的鼻腔鼻竇組織；二是徹底切除腫瘤基底部及其鄰近的粘膜和骨質(zhì)。本病傳統(tǒng)術式為鼻外進路,但其創(chuàng)傷大、面部遺留疤痕,尤其是對鼻腔鼻竇的功能性保護不夠。大量臨床資料證實鼻外徑路與鼻內(nèi)鏡下手術的治療效果并無顯著性差異。近年來隨著鼻內(nèi)鏡微創(chuàng)技術的發(fā)展和成熟,應用精細的手術解剖技術處理病變也逐漸成熟,患者也更容易接受。 本文通過臨床上較常見的三種術式：單純鼻內(nèi)鏡手術、鼻內(nèi)鏡輔助下的Caldwell-Luc手術和鼻側(cè)切開術治療鼻腔鼻竇內(nèi)翻性乳頭狀瘤,對術后復發(fā)率進行統(tǒng)計分析,探討鼻內(nèi)鏡手術在鼻內(nèi)翻性乳頭狀瘤治療中的臨床價值。 方法 1臨床病例資料：本文選取鄭州大學第一附屬醫(yī)院2005年6月～2010年6月的43例住院NIP患者,所有病例隨訪資料完整。 2手術方式及分級方法：通過病例的登記表進行回顧性分析,手術方式采用單純鼻內(nèi)鏡手術、鼻內(nèi)鏡輔助下的Caldwell-Luc手術或鼻側(cè)切開術,其中接受單純鼻內(nèi)鏡手術治療的病例18例,接受鼻內(nèi)鏡輔助下Caldwell-Luc手術方法治療的病例15例,接受鼻側(cè)切手術方法治療的病例10例。對其術后復發(fā)情況進行跟蹤隨訪,對于每個病例采用Krouse方法分級,且分別對相同級別三種手術方法的復發(fā)率進行列表計算,術后平均隨訪1.7年。 3統(tǒng)計學分析：應用SPSS17.0統(tǒng)計軟件進行計算分析,采用卡方檢驗(X檢驗),檢驗標準：α=0.05。 結(jié)果 總復發(fā)率為9.3%。單純鼻內(nèi)鏡手術Ⅰ級組復發(fā)率為11.1%,Ⅲ級組復發(fā)率為33.3%,鼻側(cè)切術Ⅲ級組復發(fā)率為25.0%,Ⅳ級組復發(fā)率為33.3%。臨床分期相同的病患采用三種術式的療效無明顯差異。一次手術治愈者37例,術后復發(fā)行二次手術者4例,二次術后無再次復發(fā)。 結(jié)論 1鼻內(nèi)窺鏡下手術是治療Ⅰ～Ⅱ級鼻內(nèi)翻性乳頭狀瘤一種較好的方法,對于病變主要侵及竇口鼻道復合體、后組篩竇及蝶竇的Ⅲ級病例行鼻內(nèi)鏡下鼻竇手術也可有良好效果。其主要優(yōu)點是視野清晰、避免了面部切口、術后較少阻塞淚道及較好的保留局部結(jié)構(gòu)和鼻腔鼻竇粘膜功能。 2對累及上頜竇內(nèi)、外側(cè)壁和底壁的Ⅲ級病例聯(lián)合柯-陸進路手術可取得較好療效,對Ⅳ級病例采用鼻側(cè)切為首選,鼻內(nèi)鏡術中可有輔助作用。 3鼻內(nèi)窺鏡手術治療復發(fā)病例、雙側(cè)發(fā)病病例仍有較好效果。 4鼻內(nèi)窺鏡對NIP的術前檢查及術后復查都具有明顯的優(yōu)勢,可早期發(fā)現(xiàn)病變,術后及時清除復發(fā)病變。
[Abstract]:Objective and background nasal inverted papilloma (nasal inverted papilloma, NIP) is a common benign tumor in nasal cavity and nasal sinus mucosa. Its clinical characteristics are that it can easily recur, can destroy the surrounding bone and normal anatomical structure, and has the tendency of malignant transformation into squamous cell carcinoma. Therefore, the first choice of treatment for NIP has been surgery, the principle of surgical treatment is radical resection of tumor. The key points of the operation are as follows: first, the tumor and its involved nasal and paranasal sinuses should be completely removed; second, the base of the tumor and its adjacent mucous membrane and bone should be completely removed. The traditional operation of this disease is external nasal approach, but its trauma, facial scars, especially the functional protection of nasal sinuses is not enough. A great deal of clinical data confirmed that there was no significant difference in the treatment effect between external nasal approach and endoscopic sinus surgery. In recent years, with the development and maturity of endoscopic minimally invasive techniques, the use of fine surgical anatomy techniques to deal with lesions is gradually mature, patients are also more easily accepted. In this paper, we analyzed the recurrence rate of inverted papilloma of nasal cavity and paranasal sinuses by three common methods: simple endoscopic surgery, endoscopic Caldwell-Luc operation and lateral nasal incision. To investigate the clinical value of endoscopic sinus surgery in the treatment of nasal inverted papilloma. Methods 1 Clinical data: 43 patients with NIP were selected from the first affiliated Hospital of Zhengzhou University from June 2005 to June 2010. All cases were followed-up with complete data. 2 methods of operation and classification: retrospective analysis was made through the registration form of the cases. The operation was performed by simple endoscopic surgery, endoscopic Caldwell-Luc operation or lateral nasal incision. Among them, 18 cases were treated by simple endoscopic surgery, 15 cases were treated by Caldwell-Luc method, and 10 cases were treated by nasal lateral resection. The recurrence rate was followed up, each case was classified by Krouse method, and the recurrence rate of three surgical methods of the same grade was calculated. The average follow-up was 1.7 years. 3 Statistical analysis: the statistical software of SPSS17.0 was used to calculate and analyze. The chi-square test (X test) was used. The test standard was 偽 = 0.05. Results the total recurrence rate was 9.3%. The recurrence rate of grade 鈪，
本文編號：2275703
[Abstract]:Objective and background nasal inverted papilloma (nasal inverted papilloma, NIP) is a common benign tumor in nasal cavity and nasal sinus mucosa. Its clinical characteristics are that it can easily recur, can destroy the surrounding bone and normal anatomical structure, and has the tendency of malignant transformation into squamous cell carcinoma. Therefore, the first choice of treatment for NIP has been surgery, the principle of surgical treatment is radical resection of tumor. The key points of the operation are as follows: first, the tumor and its involved nasal and paranasal sinuses should be completely removed; second, the base of the tumor and its adjacent mucous membrane and bone should be completely removed. The traditional operation of this disease is external nasal approach, but its trauma, facial scars, especially the functional protection of nasal sinuses is not enough. A great deal of clinical data confirmed that there was no significant difference in the treatment effect between external nasal approach and endoscopic sinus surgery. In recent years, with the development and maturity of endoscopic minimally invasive techniques, the use of fine surgical anatomy techniques to deal with lesions is gradually mature, patients are also more easily accepted. In this paper, we analyzed the recurrence rate of inverted papilloma of nasal cavity and paranasal sinuses by three common methods: simple endoscopic surgery, endoscopic Caldwell-Luc operation and lateral nasal incision. To investigate the clinical value of endoscopic sinus surgery in the treatment of nasal inverted papilloma. Methods 1 Clinical data: 43 patients with NIP were selected from the first affiliated Hospital of Zhengzhou University from June 2005 to June 2010. All cases were followed-up with complete data. 2 methods of operation and classification: retrospective analysis was made through the registration form of the cases. The operation was performed by simple endoscopic surgery, endoscopic Caldwell-Luc operation or lateral nasal incision. Among them, 18 cases were treated by simple endoscopic surgery, 15 cases were treated by Caldwell-Luc method, and 10 cases were treated by nasal lateral resection. The recurrence rate was followed up, each case was classified by Krouse method, and the recurrence rate of three surgical methods of the same grade was calculated. The average follow-up was 1.7 years. 3 Statistical analysis: the statistical software of SPSS17.0 was used to calculate and analyze. The chi-square test (X test) was used. The test standard was 偽 = 0.05. Results the total recurrence rate was 9.3%. The recurrence rate of grade 鈪，
本文編號：2275703
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