Makihara Seiichiro, Kariya Shin, Naito Tomoyuki, Uraguchi Kensuke, Matsumoto Junya, Noda Yohei, Okano Mitsuhiro, Nishizaki Kazunori
Department of Otolaryngology-Head & Neck Surgery, Kagawa Rosai Hospital, Kagawa, Japan.
Department of Otolaryngology-Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Auris Nasus Larynx. 2019 Oct;46(5):748-753. doi: 10.1016/j.anl.2019.02.007. Epub 2019 Mar 2.
The treatment of all forms of sinonasal inverted papilloma (IP) is a complete, wide, local resection. The main surgical purpose is to remove all diseased mucosa and mucoperiosteum, together with a cuff of normal-looking mucosa at the attachment site, followed by drilling and/or coagulation. Our aim is to present our experiences in endoscopic surgical management of IP by using attachment-oriented excision.
We present 20 cases of sinonasal IP. The data collected includes the histopathological diagnosis, staging, extension of the tumor, tumor attachment site, approach to surgery, serum squamous cell carcinoma antigen (SCCA) level, and recurrences.
All patients underwent endoscopic surgery. A Caldwell-Luc operation was required in addition to the endoscopic surgery in one case. There was one case of recurrence (5%). After the additional operation, there was no recurrence. The tumor attachment sites vary, and the case of recurrence had a wide attachment site at the primary surgery. No major intra- or post-operative complications were observed.
The present study shows that attachment-oriented excision for IP is useful for complete resection of IP. Surgeons should choose the surgical approach according to the location of the tumor attachment site rather than the Krouse staging system.
所有类型的鼻窦内翻性乳头状瘤（IP）的治疗方法均为完整、广泛的局部切除。主要手术目的是切除所有病变黏膜和黏膜骨膜，以及附着部位外观正常的黏膜袖，随后进行钻孔和/或凝固。我们的目的是介绍我们采用以附着部位为导向的切除术对IP进行内镜手术治疗的经验。
我们呈现20例鼻窦IP病例。收集的数据包括组织病理学诊断、分期、肿瘤范围、肿瘤附着部位、手术入路、血清鳞状细胞癌抗原（SCCA）水平及复发情况。
所有患者均接受了内镜手术。1例患者除内镜手术外还需行柯陆氏手术。有1例复发（5%）。再次手术后未再复发。肿瘤附着部位各异，复发病例在初次手术时附着部位较宽。未观察到严重的术中或术后并发症。
本研究表明，以附着部位为导向的IP切除术有助于IP的完整切除。外科医生应根据肿瘤附着部位的位置而非克劳斯分期系统来选择手术入路。
