Sautter Nathan B, Cannady Steven B, Citardi Martin J, Roh Hwan-Jung, Batra Pete S
Section of Nasal and Sinus Disorders, Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Am J Rhinol. 2007 May-Jun;21(3):320-3. doi: 10.2500/ajr.2007.21.3020.
Lateral rhinotomy with medial maxillectomy has served as the standard for surgical management of inverted papilloma (IP) in the pre-endoscopic era; since the late 1980s, endoscopic techniques have emerged as the minimally invasive alternative. The objective of this study was twofold: (1) to compare operative parameters, complications, and recurrence rates and (2) predictive factors for recurrence for open versus endoscopic cases of IP resection.
Retrospective data analysis was performed on 68 patients with histopathologically confirmed IP treated at a tertiary care medical center from January 1983 to May 2005. Parameters for comparison included operative time (OT), estimated blood loss (EBL), length of hospital stay (HS), complications, and recurrence rate. Predictive factors for recurrence including open versus endoscopic cases, primary versus secondary IP, and tumor by Krouse stage were analyzed.
The average age at time of presentation was 57.4 years with a male/female ratio of 2.2:1. Forty-nine patients underwent endoscopic resection, 13 patients underwent open resection, and 6 patients underwent limited open resection. Average OT and EBL were statistically similar for the three groups, whereas the average HS was statistically shorter (p = 0.002) for the endoscopic group. Biopsy-proven recurrence was noted in 11 (22%) endoscopic cases, 5 (39%) open cases, and 3 (50%) limited open cases. After reresection, all patients were free of disease. Mean follow-up was 16 months, 56 months, and 69 months for the endoscopic, open, and limited open groups, respectively. Analysis of predictive factors indicated that the surgical approach and primary versus secondary IP, regardless of approach, did not statistically impact recurrence rate. Chi-square analysis illustrated that patients with advanced-stage IP had a higher risk of recurrence (p = 0.002), regardless of surgical technique.
In this series, endoscopic resection of IP was associated with shorter HS and equivalent EBL and OT compared with the open groups. The overall recurrence rate was lower in the endoscopic group with acceptable morbidity compared with the open and limited open groups. Thus, the endoscopic approach may serve as a superior alternative to the open approaches for successful extirpation of IP.
在鼻内镜时代之前，外侧鼻切开术联合上颌骨内侧切除术一直是内翻性乳头状瘤（IP）手术治疗的标准方法；自20世纪80年代末以来，鼻内镜技术已成为微创替代方法。本研究的目的有两个：（1）比较手术参数、并发症和复发率；（2）分析IP切除开放手术与内镜手术病例的复发预测因素。
对1983年1月至2005年5月在一家三级医疗中心接受组织病理学确诊为IP的68例患者进行回顾性数据分析。比较的参数包括手术时间（OT）、估计失血量（EBL）、住院时间（HS）、并发症和复发率。分析复发的预测因素，包括开放手术与内镜手术病例、原发性与继发性IP以及根据Krouse分期的肿瘤情况。
患者就诊时的平均年龄为57.4岁，男女比例为2.2:1。49例患者接受了内镜切除术，13例患者接受了开放切除术，6例患者接受了有限开放切除术。三组的平均OT和EBL在统计学上相似，而内镜组的平均HS在统计学上较短（p = 0.002）。11例（22%）内镜手术病例、5例（39%）开放手术病例和3例（50%）有限开放手术病例经活检证实复发。再次切除后，所有患者均无疾病。内镜组、开放手术组和有限开放手术组的平均随访时间分别为16个月、56个月和69个月。预测因素分析表明，手术方式以及原发性与继发性IP，无论手术方式如何，对复发率在统计学上均无影响。卡方分析表明，晚期IP患者的复发风险较高（p = 0.002），无论手术技术如何。
在本系列研究中，与开放手术组相比，IP的内镜切除术与较短的HS以及相当的EBL和OT相关。内镜组的总体复发率低于开放手术组和有限开放手术组，且发病率可接受。因此，内镜手术方法可能是成功切除IP的开放手术方法的更好替代方法。
