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目的探讨不同手术方式治疗鼻腔鼻窦内翻性乳头状瘤(NIP)的临床疗效。方法选取2009年2月至2016年8月间第三军医大学第二附属医院收治的126例NIP患者。根据手术方式不同分为切开组(鼻侧切开术,20例)、内镜组(鼻内镜下手术,58例)和联合组(鼻内镜下手术+柯路氏进路,48例)三组。比较三组患者的术后复发率、术中出血量及术后并发症发生率。结果切开组患者中,6例患者发生并发症,包括视力衰退1例,脑脊液鼻漏2例,伤口麻木2例,眼睛流泪1例;内镜组患者中,4例患者发生并发症,包括脑脊液鼻漏1例,伤口麻木2例,眼睛流泪1例;联合组患者中,6例患者发生并发症,包括视力衰退1例,脑脊液鼻漏2例,伤口麻木1例,眼睛流泪2例。三组患者术后并发症发生率比较,差异有统计学意义(P<0.05)。切开组患者术后并发症发生率高于内镜组患者,差异有统计学意义(P<0.05)。三组患者术中出血量比较,差异有统计学意义(P<0.01),其中切开组患者术中出血量明显高于内镜组患者与联合组患者,差异均有统计学意义(均P<0.01)。三组患者术后肿瘤复发率比较,差异有统计学意义(P=0.01)。切开组术后复发率为40.0%(8/20),高于内镜组的12.1%(7/58)和联合组的14.6%(7/48),差异均有统计学意义(均P<0.05)。结论鼻内镜下手术与鼻内镜下手术+柯路式进路治疗NIP患者的临床疗效明显优于鼻侧切开术,术后肿瘤复发率、术中出血量及术后并发症发生率均较低,值得推广。
Objective To investigate the clinical effects of different surgical methods in the treatment of nasal inverted papilloma (NIP). Methods 126 cases of NIP patients admitted to the Second Affiliated Hospital of Third Military Medical University from February 2009 to August 2016 were selected. According to the different surgical methods, the patients were divided into incision group (nasal incision, 20 cases), endoscopic group (endoscopic surgery, 58 cases) and combined group (endoscopic surgery + Corus route, 48 Example) Three groups. The postoperative recurrence rate, intraoperative blood loss and postoperative complication rate were compared between the three groups. Results Among the patients in the incision group, complications occurred in 6 patients, including 1 case of vision loss, 2 cases of cerebrospinal fluid rhinorrhea, 2 cases of numbness and 1 case of eye crying. Among the patients in endoscopic group, 4 cases developed complications including 1 case of cerebrospinal fluid rhinorrhea, 2 cases of wound numbness and 1 case of eye tearing. Among the patients in combination group, complications occurred in 6 cases, including 1 case of visual acuity decline, 2 cases of cerebrospinal fluid rhinorrhea, 1 case of numbness and 2 cases of eye tears. The incidence of postoperative complications in the three groups was statistically significant (P <0.05). The incidence of postoperative complications in the incision group was significantly higher than that in the endoscopic group (P <0.05). The bleeding volume in the three groups was statistically significant (P <0.01). The bleeding volume in the incision group was significantly higher than that in the endoscopic group and the combined group (all P <0.01). The recurrence rate of the three groups of patients after surgery, the difference was statistically significant (P = 0.01). The recurrence rate was 40.0% (8/20) in the incision group, which was higher than that in the endoscopic group (12.1%, 7/58) and in the combined group (14.6%, 7/48) (all P <0.05). Conclusions The clinical curative effect of endoscopic sinus surgery and endoscopic sinus surgery plus Keluotai approach in treating NIP patients is obviously better than that of nasal incision, tumor recurrence rate, intraoperative blood loss and postoperative complication rate Are lower, it is worth promoting.