經鼻內視鏡鉀鈦磷雷射手術治療鼻腔竇倒生性乳突瘤之經驗

Experience of Using KTP Laser for Endoscopic Tumor Excision in Patients with Sinonasal Inverted Papilloma

陳韋智(Wei-Chih Chen) ； 蔣敬文(Ching-Wen Chiang)

《台灣耳鼻喉頭頸外科雜誌》 52卷2期 (2017/06) Pp. 64-69

https://doi.org/10.6286/2017.52.2.64

摘要

背景：鼻腔鼻竇倒生性乳突瘤因其局部侵犯性強、高復發率及可能伴隨惡性變化的特性，需完全根除腫瘤。本篇研究分析本院以經鼻內視鏡鉀鈦磷（KTP）雷射手術治療鼻腔鼻竇倒生性乳突瘤之經驗。方法：回溯性收集自2011年6月至2016年10月期間，在本院因倒生性乳突瘤接受經鼻內視鏡KTP雷射腫瘤切除手術之病患共計11名，納入分析。結果：11名病患，有8名男性與3名女性。年齡分布為50到81歲，平均為64.2歲。分析術前電腦斷層掃描及術中發現，將病患依Krouse系統分期為5名T2（45%），5名T3（45%），1名T4（9%），沒有T1的病人。術中平均出血量為109 ml。術後無嚴重併發症。所有病患歷經4到68個月的追蹤，至今尚未有復發的跡象。結論：對於侷限於鼻腔鼻竇內的倒生性乳突瘤，經鼻內視鏡KTP雷射腫瘤切除手術不但擁有良好的切割及止血能力，還能藉由燒灼腫瘤基部骨頭來降低復發率，其術後併發症很少，是值得採用的方法。

關鍵字

inverted papilloma ； endoscopic surgery ； KTP laser（倒生性乳突瘤 ； 內視鏡手術 ； 鉀鈦磷雷射）

並列摘要

BACKGROUND: A sinonasal inverted papilloma is characterized by local destruction, high recurrence rate, and potential for malignant change. Complete surgical extirpation is the main aim of treatment. This study analyzes the experience of using endoscopic surgery with a 532-nm potassium titanyl phosphate (KTP-532) laser for sinonasal inverted papilloma management in our hospital. MATERIALS AND METHODS: From June 2011 to October 2016, 11 patients diagnosed with inverted papillomas underwent endoscopic tumor excision with KTP laser. We retrospectively reviewed their age, sex, and preoperative examination findings, including nasal endoscopy and computed tomography scan findings. The Krouse staging system was used for tumor staging. The operative and postoperative followup data were collected and analyzed. RESULTS: Among the 11 patients, eight (72%) were males and three (28%) were females, with an average age of 64.2 years (range: 50-81). On analyzing the preoperative computed tomography scan and intraoperative endoscopic findings, the patients were classified as follows according to the Krouse staging system: 5 in T2 (45%), 5 in T3 (45%), and 1 in T4 (9%). There were no patients in T1. All patients underwent endoscopic surgery with KTP laser. The average blood loss during the operation was 109 ml. No complications were observed. After 4-68 months of postoperative followup, recurrence has not been found. CONCLUSIONS: For inverted papillomas limited to the sinonasal cavity, endoscopic tumor excision with KTP laser is a good option. This technique offers excellent hemostasis and accurate excision. It also reduces the recurrence rate by ablating the bone underlying the tumor base. The complication rate is low.

並列關鍵字

inverted papilloma ； endoscopic surgery ； KTP laser