Lee Ta-Jen, Huang Shiang-Fu, Huang Chi-Che
Department of Otolaryngology, Chang Gung Memorial Hospital, Chang Gung University, No 199, Tung-Hwa N Road, Taipei 105, Taiwan.
Head Neck. 2004 Feb;26(2):145-53. doi: 10.1002/hed.10350.
This retrospective study was designed to evaluate the efficacy of tailored endoscopic surgery. Tailored endoscopic surgery aims at resecting the inverted papilloma completely with a customized surgical approach, especially when an en-bloc excision cannot be comprehensively or routinely achieved because of the immense extent of the tumor.
Between November 1991 and March 2002, 43 patients with sinonasal inverted papillomas were treated by tailored endoscopic surgery. The average duration of follow-up for this population was 25.3 months (range, 9-150 months). A staging system developed by Krouse was adopted for tumor grading. On the basis of tailored endoscopic surgery, 15 localized lesions and 12 smaller extensive lesions (Krouse stages 1 and 2) were treated by ordinary endoscopic resection, whereas 16 larger extensive lesions (Krouse stages 3 and 4) in which the tumors were immense were subjected to sequential segmental endoscopic surgery (SSES). Seven of these 16 larger extensive lesions combined with endoscopic medial maxillectomy because of extensive encroachment of maxillary sinus antrum.
Four patients (9.3%) had residual disease, each requiring one revision surgery. All tumors were successfully resected. No patient required lateral rhinotomy or midfacial degloving procedure. No major complications were encountered in any of the patients. None of the patients had residual disease at the time of this writing.
Tailored endoscopic surgery is a safe and effective treatment that obviates the need for more extensive surgery for the management of inverted papilloma. Proper preoperative evaluations, intraoperative determination of extent and attachment of the tumor, close endoscopic follow-up, and expert application of endoscopic techniques are the keys to the successful use of tailored endoscopic surgery.
本回顾性研究旨在评估定制内镜手术的疗效。定制内镜手术旨在通过定制的手术方法完全切除内翻性乳头状瘤，尤其是当肿瘤范围巨大而无法全面或常规地实现整块切除时。
1991年11月至2002年3月期间，43例鼻窦内翻性乳头状瘤患者接受了定制内镜手术治疗。该人群的平均随访时间为25.3个月（范围9 - 150个月）。采用Krouse开发的分期系统对肿瘤进行分级。基于定制内镜手术，15例局限性病变和12例较小的广泛性病变（Krouse分期1和2）采用普通内镜切除术治疗，而16例肿瘤巨大的较大广泛性病变（Krouse分期3和4）则接受序贯节段性内镜手术（SSES）。这16例较大广泛性病变中有7例因上颌窦广泛受侵而联合内镜下上颌骨内侧切除术。
4例患者（9.3%）有残留病灶，均需再次手术。所有肿瘤均成功切除。无一例患者需要行鼻侧切开术或面中部掀翻术。所有患者均未发生重大并发症。在撰写本文时，所有患者均无残留病灶。
定制内镜手术是一种安全有效的治疗方法，无需进行更广泛的手术来处理内翻性乳头状瘤。正确的术前评估、术中确定肿瘤的范围和附着情况、密切的内镜随访以及内镜技术的专业应用是成功使用定制内镜手术的关键。
