Department of Otorhinolaryngology, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo 105-8461, Japan; Department of Otolaryngology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.
Department of Otorhinolaryngology, Tohoku Rosai Hospital, Sendai, Japan.
Auris Nasus Larynx. 2020 Jun;47(3):410-414. doi: 10.1016/j.anl.2019.10.006. Epub 2019 Nov 12.
Sinonasal inverted papilloma can be resected endoscopically, but has a risk of recurrence. This risk can be minimized by identifying the pedicle of the tumor and ensuring complete resection. Intraoperative bleeding, particularly from the tumor, decreases endoscopic visualization and contributes to failure to identify the tumor pedicle, and piecemeal resection with dissection of the non-tumoral mucosa makes it impossible to distinguish the tumor pedicle. Previously reported transseptal access with crossing multiple incisions (TACMI) increases mobility of an inverted papilloma within the otherwise restricted nasal cavity. This technique often allows en bloc resection complete with the pedicle and control of bleeding.
We retrospectively reviewed our patients who underwent endoscopic resection of inverted papilloma with or without TACMI and compared the operating times, estimated blood loss, and en bloc resection and recurrence rates between the two groups.
Thirty-five patients underwent endoscopic resection of inverted papilloma (Krouse stage 2-4) with (n = 23) or without (n = 12) TACMI. The operating time was longer in the TACMI group (218±68 min) than in the non-TACMI group (129±33 min). Estimated blood loss was less in the TACMI group (72±103 mL vs. 120±136.5 mL) but this finding was not significant. En bloc resection was achieved in 19 patients (83%) in the TACMI group but not in any patient in the non-TACMI group. There were no recurrences in the TACMI group. Multivariate analysis showed significant relationships between estimated amount of blood loss and operating time according to Krouse stage and whether or not TACMI was performed.
Endoscopic resection of inverted papilloma with TACMI may achieve better treatment results with less blood loss.
鼻内翻性乳头状瘤可经内镜切除，但存在复发风险。通过识别肿瘤蒂并确保完全切除，可将此风险降至最低。术中出血，尤其是来自肿瘤的出血，会降低内镜的可视化程度，并导致无法识别肿瘤蒂，非肿瘤黏膜的分片切除使得无法区分肿瘤蒂。先前报道的经鼻中隔通道交叉多切口（TACMI）技术增加了鼻内翻性乳头状瘤在原本受限的鼻腔内的活动性。该技术通常可实现整块切除连同蒂部，并控制出血。
我们回顾性分析了接受内镜下鼻内翻性乳头状瘤切除术的患者，包括接受或不接受 TACMI 的患者，并比较了两组患者的手术时间、估计失血量、整块切除率和复发率。
35 例患者接受内镜下鼻内翻性乳头状瘤切除术（Krouse 分期 2-4 期），其中 23 例行 TACMI，12 例行非 TACMI。TACMI 组的手术时间（218±68min）长于非 TACMI 组（129±33min）。TACMI 组的估计失血量（72±103mL）少于非 TACMI 组（120±136.5mL），但差异无统计学意义。TACMI 组 19 例（83%）患者实现整块切除，而非 TACMI 组无患者实现整块切除。TACMI 组无复发。多因素分析显示，根据 Krouse 分期和是否行 TACMI，估计失血量与手术时间之间存在显著关系。
TACMI 联合内镜下切除鼻内翻性乳头状瘤可能会获得更好的治疗效果，并减少出血量。
