內視鏡執行局部全粘膜層切除治療上頷竇後鼻孔息肉

Endoscopic Localized Transmural Resection of Antrochoanal Polyp

周哲宇(Tse-Yu Chou) ； 江秉頴(Rayleigh Ping-Ying Chiang) ； 邱柏翰(Po-Han Chiu) ； 季照芸(Chao-Yun Chi) ； 蔡易錚(Yih-Jeng Tsai)

《台灣耳鼻喉頭頸外科雜誌》 48卷3期 (2013/09) Pp. 194-198

https://doi.org/10.6286/2013.48.3.194

摘要

背景：上頷竇後鼻孔息肉為良性病灶，生長於上頷竇並自其開孔突出而延伸至後鼻孔。其佔所有鼻息肉的4～6%，好發於兒童及年輕成人。傳統上治療以Caldwell-Luc術式為主，近年來轉以鼻竇內視鏡手術為主，但此疾病仍被認為有高復發率。本研究之目的為探討過去10年於內視鏡下作局部全粘膜層剝離併切除之治療成效。方法：由過去10年之所有接受鼻竇內視鏡手術1,588例中，篩選出確診為上頷竇後鼻孔息肉併有完整之手術記錄者。手術方式皆為內視鏡下進行局部全粘膜層切除。結果：共收錄共53個病例，男性41名，女性12名。年齡分佈從16至63歲，平均年齡35.2歲。左側病灶有30名（57%），右側病灶有23名（43%）。在有計載病灶莖部位置之25名病例中，後壁佔最多共13例（52%），其次依序下壁5例（20%），外側壁4例（16%），內側壁2例（8%），前壁1例（4%）。追蹤時間從7至42個月，平均12.3個月，復發共7例（13.2%），其中有記載莖部復發位置者，3例是位於外側壁，1例是位於後側壁。此4例其莖部位置皆同於原本位置。7名復發病患皆接受第二次相同手術，追蹤1年後均無復發。結論：本研究以鼻竇內視鏡手術執行局部全粘膜層剝離治療上頷竇後鼻孔息肉，治癒率高且成本低廉。

關鍵字

上頷竇後鼻孔息肉 ； 鼻竇內視鏡手術 ； 全粘膜層切除

並列摘要

BACKGROUND: Antrochoanal polyps are benign lesions arising from the maxillary sinus and extending to the nasal cavity and choanae. They account for 4-6% of all nasal polyps and are more frequent in young adults and children. The tranditional treatment for the disease is Caldwell-Luc surgery, but endoscopic sinus surgery has also been used recent years. However, the recurrence rate is still high. The purpose of this study is to investigate the efficacy of endoscopic localized transmural sinus mucosal resection in treating antrochoanal polyps.METHODS: The cases of antrochoanal polyps were selected from 1,588 patients receiving endoscopic sinus surgery last 10 years. Those with detailed operative notes and pathological report were included in this study. Those who were not treated by endoscopic localized transmural resection or followed up less than 3 months were excluded.RESULTS: The study group included 41males and 12 females. The age ranged from 16 to 63 years old, and the mean age was 35.2 years old. Left-sided diseases were noted in 30 patients, and there were 23 in right side. Among 25 cases with the root of antrochoanal polyps documented, 13 cases originated from the posterior wall of the maxillary sinus, 5 from the inferior, 4 from the lateral, 2 from the medial, and 1 from the anterior. The follow-up duration ranged from 7-42 months with a mean followup duration of 12.3 months. There were 7 recurrent cases. All 7 patients underwent a second operation with the same surgical method, and no recurrence was noted after a 1-year follow up.CONCLUSIONS: Endoscopic localized transmural sinus mucosal dissection is effective in treating antrochoanal polyps.

並列關鍵字

antrochoanal polyp ； endoscopic sinus surgery ； transmural resection