鼻及鼻竇倒生性乳突瘤

背景：鼻及鼻竇倒生性乳突瘤在臨床上並不常見，但是因為高復發率及可能伴隨惡性腫瘤的特性，讓治療充滿了挑戰。本文分析了過去10年，在本院以鼻內視鏡手術治療鼻及鼻竇倒生性乳突瘤病人的經驗。材料及方法：本文回顧自2001年1月至2011年1月共10年間，總共23名病患以鼻內視鏡手術發現為倒生性乳突瘤的病患。並回溯分析其年齡，性別，臨床症狀。每位病人皆接受完整術前檢查，包括內視鏡檢查和電腦斷層。我們以Krouse system為腫瘤做分期，並針對術後追蹤進行分析。結果：23名病人裡，男性為17名，女性6名。年齡層介於25到78歲，平均年齡50.6歲。最常見的初診症狀包含鼻塞（87%），流鼻水或鼻水倒流（43%）。以術前電腦斷層及鼻內視鏡檢查分析，透過Krouse system將腫瘤分為4期，分別是T1有13名（78%），T2有7名（29%），T3有3名（13%），沒有T4的病人。所有病人經鼻內視鏡手術後，病理報告皆確診為倒生性乳突瘤，術後歷經9到58個月的追蹤，其中有兩例復發（9%），分別在術後第25及36個月後。經再次鼻內視鏡手術後追蹤至今尚未有復發情況。結論：使用鼻內視鏡手術治療早期倒生性乳突瘤，已成為目前治療的主流。不但術後恢復較傳統手術快，併發症低，復發率也不高。然因復發機制未明，所以長期以鼻內視鏡追蹤檢查，對早期診治復發是必要的。

關鍵字

倒生性乳突瘤；內視鏡手術

並列摘要

BACKGROUND: Sinonasal inverted papilloma is uncommon in clinical practice. However, its characteristics of easier relapse and relationship to malignancy make the surgery more challenging. This article analyzes the experience of patients' surgical treatment for inverted papilloma in our hospital over the past decade.MATERIALS AND METHODS: Twenty three patients were diagnosed with inverted papilloma after endoscopic sinus surgery form January 2001 to January 2011. Their age, gender, clinical symptoms were retrospectively reviewed. They all received complete preoperative check, including nasal endoscopy examination and computed tomography scan. Krouse system was used for tumor grading. The postoperative follow data were collected and analyzed.RESULTS: There are 23 patients, 17 men and 6 women, ranged from 25 to 78 years old with an average age of 50.6 years old. The most common newly diagnosed symptoms include nasal congestion (87%), runny nose or postnasal drip (43%). Analysis of the preoperative computed tomography scan and nasal endoscopic reports, the tumor was divided into four Krouse systems, T1 (78%), T2 (29%), T3 (13%). There is no T4 patient. All patients used transnasal endoscopic approach. The pathology reports are confirmed for inverted papilloma. After 9 to 58 months of postoperative follow-up, two cases (5%) had recurrent papilloma in 25 and 36 months, respectively. These patients underwent a repeat endoscopic resection. Recurrence has not yet been found.CONCLUSIONS: The use of endoscopic Sinonasal surgery of inverted papilloma has become the mainstream of current treatment. Not only postoperative recovery was faster than traditional surgery, but also with lower complication and recurrence rate. In order to avoid recurrence, long-term endoscopic tracking is necessary for early detection of the recurrent lesion.

並列關鍵字

inverted papilloma ； endoscopic surgery

國際替代計量

鼻及鼻竇倒生性乳突瘤

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