Ohki Masafumi, Kikuchi Shigeru
Department of Otolaryngology, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama, 350-8550 Japan.
Indian J Otolaryngol Head Neck Surg. 2019 Nov;71(Suppl 3):2186-2193. doi: 10.1007/s12070-019-01625-x. Epub 2019 Feb 18.
To compare the outcomes of various surgical approaches to resect sinonasal inverted papilloma and to discuss their advantages and disadvantages. A retrospective chart review of 61 consecutive patients with sinonasal inverted papilloma was performed. Surgical treatment included non-demucosation endoscopic sinus surgery (ESS), demucosation ESS, endonasal medial maxillectomy (EMM), Draf type 3, Caldwell-Luc surgery, Denker, Killian, and lateral rhinotomy. Recurrence rates were compared between endonasal and external approaches and between demucosation and non-demucosation. After the first curative surgery, the non-demucosation ESS, endonasal demucosation (demucosation ESS, EMM, and Draf type 3), and external surgery showed recurrence rates of 61.5%, (8/13), 0.0% (0/21), and 7.4% (2/27), respectively. A significantly lower recurrence rate was observed in the endonasal demucosation ( < 0.001) and in the demucosation ESS group ( < 0.001) in comparison with the non-demucosation ESS. However, as for recurrence rate, no statistically significant difference was observed between endonasal surgery and external surgery ( = 0.162). Demucosation is a better strategy for the treatment of inverted papilloma than is non-demucosation. Demucosation is the key procedure for preventing recurrence.
比较各种手术方法切除鼻窦内翻性乳头状瘤的疗效，并探讨其优缺点。对61例连续的鼻窦内翻性乳头状瘤患者进行回顾性病历分析。手术治疗包括非去黏膜内镜鼻窦手术（ESS）、去黏膜ESS、鼻内镜下中鼻甲切除术（EMM）、Draf 3型手术、Caldwell-Luc手术、Denker手术、Killian手术和鼻侧切开术。比较鼻内手术和外部手术以及去黏膜手术和非去黏膜手术之间的复发率。首次根治性手术后，非去黏膜ESS组（13例中的8例）、鼻内去黏膜组（去黏膜ESS、EMM和Draf 3型手术，21例中的0例）和外部手术组（27例中的2例）的复发率分别为61.5%、0.0%和7.4%。与非去黏膜ESS组相比，鼻内去黏膜组（<0.001）和去黏膜ESS组（<0.001）的复发率显著更低。然而，就复发率而言，鼻内手术和外部手术之间未观察到统计学上的显著差异（=0.162）。与非去黏膜手术相比，去黏膜手术是治疗内翻性乳头状瘤的更好策略。去黏膜是预防复发的关键步骤。
