Díaz Molina Juan P, Llorente Pendas José L, Rodrigo Tapia Juan P, Alvarez Marcos Cesar, Obeso Agüera Sergio, Suárez Nieto Carlos
Hospital Universitario Central de Asturias, Universidad de Oviedo, España.
Acta Otorrinolaringol Esp. 2009 Nov-Dec;60(6):402-8. doi: 10.1016/j.otorri.2009.05.002. Epub 2009 Aug 15.
Inverted papillomas are benign sinonasal lesions that arise primarily from the lateral nasal wall which are characterized by their tendency to recur and propensity to be associated with malignancy. The aim of this work is to analyze our experience in the treatment of these lesions, especially through the endoscopic approach.
We present 61 cases of sinonasal inverted papillomas that were treated at our hospital since 1983. The patients were studied by age, gender, site of presentation of the tumor, symptoms, radiologic studies, surgical treatment and evolution. The mean follow-up was 51 months (range 6-228 months).
Thirty eight of the patients (62%) were males and 23 females (38%). The average age was 58 years (range 22-80). The most common symptom was unilateral nasal obstruction in 91% of the cases, followed by rhinorrhea in 46%. The most frequent location was the ethmoid region in 51% of cases, followed by the maxillary sinus in 28% and the lateral nasal wall in 21% of the cases. 78% of cases had associated sinusitis and the 43% polyposis. Tumours were classified with the Krouse staging system as follows: 35% stage I, 37% stage II, 18% stage III and 8% stage IV. 37% of the patients had bony erosion in the CT scan. Six of the 42 patients treated by endoscopic procedures presented recurrence (14%), compared with 6 of the 9 patients (67%) who were treated by open approaches. The average time to the recurrence was 41 months. 17% of the patients had malignant inverted papillomas, nine of them diagnosed from the beginning as malignant neoplasies and one which became malignant during follow up.
The endoscopic approach is the method of choice for the treatment of the majority of inverted papillomas. The close follow up of the patient for a large period of time is necessary for the early detection of recurrence and to allow for surgical salvage.
内翻性乳头状瘤是一种主要起源于鼻侧壁的良性鼻窦病变，其特点是易于复发且有恶变倾向。本研究的目的是分析我们在治疗这些病变方面的经验，尤其是通过内镜手术方法。
我们回顾了自1983年以来在我院接受治疗的61例鼻窦内翻性乳头状瘤患者。对患者进行了年龄、性别、肿瘤的发病部位、症状、影像学检查、手术治疗及病情演变等方面的研究。平均随访时间为51个月（范围6 - 228个月）。
38例患者（62%）为男性，23例（38%）为女性。平均年龄为58岁（范围22 - 80岁）。最常见的症状是91%的患者出现单侧鼻塞，其次是46%的患者有流涕症状。最常见的发病部位是筛窦区，占51%的病例，其次是上颌窦，占28%，鼻侧壁占21%。78%的病例伴有鼻窦炎，43%伴有鼻息肉。肿瘤根据Krouse分期系统分类如下：35%为I期，37%为II期，18%为III期，8%为IV期。37%的患者在CT扫描中有骨质侵蚀。42例接受内镜手术治疗的患者中有6例复发（14%），而9例接受开放手术治疗的患者中有6例复发（67%）。复发的平均时间为41个月。17%的患者患有恶性内翻性乳头状瘤，其中9例从一开始就被诊断为恶性肿瘤，1例在随访期间恶变。
内镜手术是治疗大多数内翻性乳头状瘤的首选方法。对患者进行长期密切随访对于早期发现复发并进行手术挽救是必要的。
