Osuch-Wójcikiewicz Ewa, Wojas Oksana, Nyckowska Jagna, Checiński Piotr, Sielska-Badurek Ewelina, Bruzgielewicz Antoni, Szwedowicz Paweł, Niemczyk Kazimierz
Katedra i Klinika Otolaryngologii, Warszawskiego Uniwersytetu Medycznego Kierownik Kliniki.
Otolaryngol Pol. 2010 Jun;64(7):73-6. doi: 10.1016/S0030-6657(10)70014-7.
INTRODUCTION: Inverted papilloma is benign epidermal neoplasm of not recognized etiology. The lesion is estimated to represent 0.5-4% of sinonasal tumors. Generally inverted papilloma is unilateral, arises from the lateral nasal wall and characterizes with local destruction and rapid growth. The tumor can possibly undergo malignant transformation. The treatment of choice is surgery, recently endoscopic approach is considered to be superior to the open approach. THE AIM OF STUDY: was evaluation of recurrent inverted papilloma treatment results in the experience of Otolaryngology Department, Medical University of Warsaw, from 1982 to 2009. MATERIAL: The group of 124 patient (66 men and 58 women) aged from 26 to 79 with inverted papilloma operated between 1982 and 2009 were enrolled in the study. Follow up was from 6 months to 27 years. RESULTS: Most common primary localization of the tumor was combined lateral nasal wall and maxillary sinus (42%). In 37% the lesion involved unilaterally the lateral nasal wall, maxillary sinus and ethmoid sinuses, rarely it was localized only in the lateral nasal wall (16.1%) and exclusively in the nasal septum (4.8%). All the patients were treated surgically, 46% of patients underwent endoscopic procedure, 37.1% lateral rhinotomy, 15% Denker rhinotomy and 1.6% midfacial degloving. Recurrence was observed in 15.3% including 57.9% after endoscopic surgery, 26% after Denker operation and 15.8% after lateral rhinotomy. Malignant transformation was observed in 5 patient (4%). All the patients with recurrent inverted papilloma were treated surgically, 5.3% of patient underwent midfacial degloving, 5.3% Caldwell-Luc operation, 10.5% endoscopic procedure, 26.3% Denker operation and 52.6% lateral rhinotomy. CONCLUSIONS: 1. Endonasal and open approach should be considered in the surgical treatment of recurrent inverted papilloma. 2. Endoscopic approach is preferred in the recent years but qualification for each method should depend on lesion localization, extent and volume. 3. Regular follow-up enables early recurrence diagnosis and treatment.
引言：内翻性乳头状瘤是一种病因不明的良性表皮肿瘤。据估计，该病变占鼻窦肿瘤的0.5 - 4%。一般来说，内翻性乳头状瘤是单侧的，起源于鼻侧壁，具有局部破坏和生长迅速的特点。该肿瘤可能会发生恶变。首选的治疗方法是手术，近年来，内镜手术被认为优于开放手术。 研究目的：评估华沙医科大学耳鼻喉科1982年至2009年期间复发性内翻性乳头状瘤的治疗结果。 材料：本研究纳入了1982年至2009年间接受手术治疗的124例年龄在26至79岁之间的内翻性乳头状瘤患者（66例男性和58例女性）。随访时间为6个月至27年。 结果：肿瘤最常见的原发部位是鼻侧壁和上颌窦联合处（42%）。37%的病变单侧累及鼻侧壁、上颌窦和筛窦，很少仅局限于鼻侧壁（16.1%）和仅位于鼻中隔（4.8%）。所有患者均接受了手术治疗，46%的患者接受了内镜手术，37.1%接受了鼻侧切开术，15%接受了邓克氏鼻切开术，1.6%接受了面中部掀翻术。观察到15.3%的患者复发，其中内镜手术后复发率为57.9%，邓克氏手术后为26%，鼻侧切开术后为15.8%。5例患者（4%）发生了恶变。所有复发性内翻性乳头状瘤患者均接受了手术治疗，5.3%的患者接受了面中部掀翻术，5.3%接受了考德威尔 - 卢氏手术，10.5%接受了内镜手术，26.3%接受了邓克氏手术，52.6%接受了鼻侧切开术。 结论：1. 复发性内翻性乳头状瘤的手术治疗应考虑鼻内和开放手术方法。2. 近年来首选内镜手术方法，但每种方法的选择应取决于病变的部位、范围和体积。3. 定期随访有助于早期复发的诊断和治疗。
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