Lian Fang, Juan Hong
Department of ENT, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang, China.
J Craniofac Surg. 2012 Jan;23(1):e44-8. doi: 10.1097/SCS.0b013e318241dae7.
Sinonasal inverted papilloma (IP) is noted for its high rate of recurrence. Although many clinical studies have demonstrated the effectiveness of the endoscopic approach for IP, only a few published reports have studied the efficacy of endoscopic surgery for recurrent IP, and the surgical approach has been the subject of much debate. In this study, our objective was to demonstrate the effectiveness and limitations of 3 different endoscopic procedures used for the treatment of recurrent IP. From January 2001 to June 2008, 26 patients with recurrent IP were treated with endoscopic surgery. Previous surgeries included 5 cases of lateral rhinotomy and 21 cases of endoscopic endonasal surgery. With preoperative computed tomography or magnetic resonance imaging, we attempted to identify the sites of origin and attachment of IP. Three types of resection were used: basically, purely endoscopic endonasal resection was used for tumors arising from lateral nasal wall, ethmoid sinus, and frontal sinus; endoscope-assisted medial maxillectomy was used for tumors originating from the medial wall of the maxillary sinus; and the combination of the endoscopic and Caldwell-Luc procedure was used for tumors involving the anterior, inferior, superior, or lateral portion of the maxillary sinus. Efficacy was evaluated strictly by endoscopic examination or computed tomography in a mean follow-up of 28.2 months (range, 13-42 mo). Three types of procedure were performed in 6, 10, and 10 patients, respectively. Three patients had residual recurrence within 2 months after the resection. One tumor was confirmed malignant. There were no major complications encountered in the patients. In conclusion, different endoscopic strategies are modulated in relation to the attachment of recurrent tumor. The purely endoscopic endonasal procedure is suited for the treatment of recurrent IP limited to the nasal cavity, the ethmoid sinus, and the frontal sinus. As to tumors arising from the maxillary sinus, medial maxillectomy or an additional Caldwell-Luc surgery should be performed.
鼻腔鼻窦内翻性乳头状瘤（IP）以其高复发率而闻名。尽管许多临床研究已证明内镜手术治疗IP的有效性，但仅有少数已发表的报告研究了内镜手术治疗复发性IP的疗效，且手术方式一直是诸多争论的焦点。在本研究中，我们的目的是证明用于治疗复发性IP的3种不同内镜手术的有效性和局限性。2001年1月至2008年6月，26例复发性IP患者接受了内镜手术治疗。既往手术包括5例鼻侧切开术和21例鼻内镜鼻窦手术。通过术前计算机断层扫描（CT）或磁共振成像（MRI），我们试图确定IP的起源部位和附着点。采用了3种切除方式：基本上，对于起源于鼻腔外侧壁、筛窦和额窦的肿瘤，采用单纯鼻内镜下鼻内切除术；对于起源于上颌窦内侧壁的肿瘤，采用鼻内镜辅助下上颌骨内侧切除术；对于累及上颌窦前、下、上或外侧部分的肿瘤，采用鼻内镜与柯-陆氏手术联合的方式。通过内镜检查或CT进行严格的疗效评估，平均随访28.2个月（范围13 - 42个月）。分别对6例、10例和10例患者进行了3种手术方式。3例患者在切除术后2个月内出现残余复发。1例肿瘤被确诊为恶性。患者未出现严重并发症。总之，针对复发性肿瘤的附着情况调整不同的内镜手术策略。单纯鼻内镜下鼻内手术适用于仅限于鼻腔、筛窦和额窦的复发性IP的治疗。对于起源于上颌窦的肿瘤，应行上颌骨内侧切除术或附加柯-陆氏手术。
