摘要
目的：廣泛性鼻息肉的外科療法，以往常採行破壞性較大的Caldwell-Luc手術併鼻內篩竇摘除術，我們嘗試以傷害性較小的內視鏡鼻竇手術(ESS)來處理，對效果不彰之病患,再輔以Caldwell-Luc手術（此種手術模式，以下稱“兩階段手術”），以減輕病人的不適。方法：自1995年1月至2004年12月間，共91位罹患廣泛性鼻息肉症之病人接受兩階段手術。所有病人皆先接受內視鏡鼻竇手術，每位病人術後皆以內視鏡定期追蹤6個月，若是病人上頜竇內有殘存或再發的息肉仍持續變大且病人膿性鼻漏嚴重時，則再輔行第二階段手術（Caldwell-Luc手術）。結果：這91位接受第一階段手術後的病人，經定期追蹤6個月後，其中81位病人症狀有顯著改善（改善率89%）。而剩下10位效果不彰之病人則再輔行Caldwell-Luc手術，結果有8位症狀完全消失，另外2位則有顯著改善。所有91位接受“兩階段手術＂之病人，術後皆未有重大併發症產生。結論：我們認為對於廣泛性鼻息肉病症而言，兩階段手術是一合理、有效的治療方式,值得採行。
並列摘要
Background and Purpose: The Caldwell-Luc and intranasal ethmoidectomy procedures were the surgical methods we used to adopt previously in order to treat cases of diffuse nasal polyposis. Nowadays, we typically attempt to undertake endoscopic sinus surgery for the same surgical purposes and also so as to attempt to reduce patient suffering. Methods: Ninety-one patients featuring diffuse nasal polyposis underwent a two-stage surgical procedure to deal with this condition over the last ten years at our institution. The stage-Ⅰ surgical procedure involved endoscopic sinus surgery and the stage-Ⅱ procedure incorporated Caldwell-Luc surgery. The stage-Ⅱ procedure was reserved only for those patients for whom the stage-Ⅰ procedure was deemed to have been a failure as determined at the six-month follow-up examination. All of these stage-Ⅱ recipients were re-evaluated six months subsequent to completion of stage-Ⅱ surgery. Results: The rate of significant symptom improvement for patients following stage-Ⅰ surgery was 89% (81/91), and stage-Ⅱ surgery proved effective to treat those failed stage-Ⅰ surgery recipients. No major complication was found for any of our patients. Conclusion: We recommend this two-stage surgical procedure as an appropriate treatment modality for diffuse nasal polyposis.
延伸閱讀
- 王興萬、陳祥霖、林炯堃、柯世豐、李正廷、蘇文勇（1992）。鼻息肉及息肉樣病變之交感神經分佈。中華民國耳鼻喉科醫學會雜誌，27(3)，208-213。https://doi.org/10.6286/1992.27.3.208
- 陳記得、林清榮（1992）。鼻息肉併廣泛性顱面侵犯－病例報告。中華民國耳鼻喉科醫學會雜誌，27(4)，359-362。https://doi.org/10.6286/1992.27.4.359
- 陳泰岳、黃弘孟（2010）。KTP雷射手術治療肥厚性下鼻甲。北市醫學雜誌，7(2)，119-124。https://doi.org/10.6200/TCMJ.2010.7.2.02
- 涂智文、江榮山、張凱明（2003）。Nasal Volume Changes after Functional Endoscopic Sinus Surgery。台灣耳鼻喉頭頸外科雜誌，38(5)，216-221。https://doi.org/10.6286/2003.38.5.216
- Chiang, C. H., Juan, K. H., Kuo, W. R., Tai, C. F., & Wu, J. R. (1996). Nasal Septal Cyst - A cases Report. The Kaohsiung Journal of Medical Sciences, 12(4), 256-259. https://doi.org/10.6452/KJMS.199604.0256