Landsberg Roee, Cavel Oren, Segev Yoram, Khafif Avi, Fliss Dan M
Department of Otolaryngology-Head and Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Am J Rhinol. 2008 Nov-Dec;22(6):629-34. doi: 10.2500/ajr.2008.22.3243.
It is well documented that inverted papillomas (IP) have a localized attachment site. Still, instead of concentrating on the attachment site, endoscopic surgeons often perform an extended resection similar to the one achieved after external surgery.
Our objective was to evaluate an attachment-oriented endoscopic surgical strategy and to determine IP attachment diameter and location.
A prospective study was conducted. Thirty-three consecutive patients who underwent endoscopic IP excision (2001--2007) were enrolled. Thirty patients had adequate follow-up. Attachment diameters were measured in 25/33 patients. Surgery included debulking, identifying the precise mucosal attachment site, subperiosteal dissection and excision of the attachment, frozen section control, and resection/drilling of underlying bone.
The mean measured attachment diameter (n = 25) was 8.4 +/- 6 mm (range, 3-23 mm). Attachment locations included maxillary sinus (39%), ethmoid sinus (21%), nasal cavity (21%), frontal sinus (6%), sphenoid sinus (6%), lamina papyracea (3%), and cribriform plate (3%). The mean follow-up (n = 30) was 40 +/- 21 months. Three patients had Krouse stage 1, 10 patients had stage 2, and 17 patients had stage 3. Nine patients had undergone previous surgeries. After attachment-oriented endoscopic surgery, three patients had persistent disease. Nasolacrimal duct stenosis was the only complication (n = 1).
Even advanced IP have small attachments. Their Identification facilitates efficacious resection with minimal morbidity.
有充分文献记载，内翻性乳头状瘤（IP）有一个局限性附着部位。然而，内镜外科医生往往不专注于附着部位，而是进行类似于外部手术的扩大切除。
我们的目的是评估一种以附着部位为导向的内镜手术策略，并确定IP的附着直径和位置。
进行了一项前瞻性研究。纳入了连续33例接受内镜下IP切除术（2001 - 2007年）的患者。30例患者有充分的随访。在33例患者中的25例测量了附着直径。手术包括肿瘤减容、确定精确的黏膜附着部位、骨膜下剥离和附着部位切除、冰冻切片检查以及对下方骨质的切除/钻孔。
测量的平均附着直径（n = 25）为8.4 ± 6 mm（范围3 - 23 mm）。附着位置包括上颌窦（39%）、筛窦（21%）、鼻腔（21%）、额窦（6%）、蝶窦（6%）、眶纸板（3%）和筛板（3%）。平均随访时间（n = 30）为40 ± 21个月。3例患者为克劳斯1期，10例为2期，17例为3期。9例患者曾接受过先前手术。在以附着部位为导向的内镜手术后，3例患者疾病持续存在。鼻泪管狭窄是唯一的并发症（n = 1）。
即使是晚期IP，其附着部位也较小。识别这些附着部位有助于以最小的发病率进行有效的切除。
