Sham C L, Woo J K, van Hasselt C A
Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong.
J Laryngol Otol. 1998 Aug;112(8):758-64. doi: 10.1017/s0022215100141611.
The results of a retrospective study of 22 patients with inverted papillomas resected by the endoscopic approach are presented with a follow-up of 33 to 96 months. Twenty-one patients had unilateral disease and one patient had bilateral involvement. None of the patients had orbital or cranial extension. One patient had synchronous carcinoma in situ. Eight patients had undergone previous surgical procedures. Following endoscopic surgery, six patients had residual disease requiring further revisions. Three of these six patients eventually required excision via limited external approaches. No patient required lateral rhinotomy or mid-facial degloving procedures. No complication occurred in any of the patients. The advantages of endoscopic surgery include precise determination of tumour extent, preservation of normal mucosa and bony structures and avoidance of external scars. Close endoscopic follow-up is mandatory to ensure early recognition and treatment of recurrent disease. Although the endoscopic approach is gaining popularity for the treatment of inverted papilloma, indiscriminate application may result in a high recurrence rate. The endoscopic approach should be performed by experienced surgeons and restricted to carefully selected patients with nasal, ethmoidal and limited maxillary disease. More extensive disease should be managed by radical external approaches or by combining endoscopic with limited external approaches.
本文报告了对22例经内镜手术切除内翻性乳头状瘤患者的回顾性研究结果，随访时间为33至96个月。21例患者为单侧病变，1例患者为双侧受累。所有患者均无眼眶或颅内侵犯。1例患者同时存在原位癌。8例患者曾接受过先前的手术。内镜手术后，6例患者有残留病变需要进一步修正。这6例患者中的3例最终需要通过有限的外部入路进行切除。没有患者需要行鼻侧切开术或面中部掀翻手术。所有患者均未发生并发症。内镜手术的优点包括精确确定肿瘤范围、保留正常黏膜和骨质结构以及避免外部瘢痕。必须进行密切的内镜随访，以确保早期识别和治疗复发性疾病。尽管内镜手术在治疗内翻性乳头状瘤方面越来越受欢迎，但不加选择地应用可能导致高复发率。内镜手术应由经验丰富的外科医生进行，并仅限于精心挑选的鼻腔、筛窦和上颌窦病变有限的患者。更广泛的病变应采用根治性外部入路或内镜与有限外部入路相结合的方法进行处理。
