两种手术方式治疗Krouse分级T2、T3上颌窦内翻性乳头状瘤的疗效及对炎性应激指标的影响

目的:对比鼻内镜下经泪前隐窝入路、鼻内镜下中下鼻窦道开窗术两种手术方式治疗Krouse分级T2、T3的上颌窦内翻性乳头状瘤的疗效及对炎性应激指标的影响。方法:回顾性分析50例上颌窦内翻性乳头状瘤患者的临床资料。根据手术方式分成A组(n=26,鼻内镜下中下鼻窦道开窗术)和B组(n=24,鼻内镜下经泪前隐窝入路)。考察两组围术期指标、炎性应激指标白介素-8(IL-8)、白介素-10(IL-10)、降钙素原(PCT)]、并发症、复发率。结果:与A组相比,B组的术中出血量更少,手术时间、术后鼻腔内创面愈合时间、住院时间更短,术后疼痛程度更轻,组间对比差异有统计学意义(P<0.05)。两组术前、术后1 d、术后10 d的IL-8、PCT水平呈先升高后降低趋势,IL-10呈先降低后升高趋势(P<0.025),B组术后1 d的IL-8、PCT水平低于A组,IL-10水平高于A组(P<0.05)。两组并发症发生率、术后复发率组间对比均无统计学意义(P>0.05)。结论:以鼻内镜下经泪前隐窝入路治疗Krouse分级为T2、T3的上颌窦内翻性乳头状瘤患者,创伤小,术后恢复快,可减轻患者炎性应激,术后并发症少,是治疗上颌窦内翻性乳头状瘤疗效较好的手术方式之一。

Therapeutic Effect of Two Surgical Methods in the Treatment of Maxillary Sinus Inverted Papilloma with Kruse Grade T2 and T3 and its Influence on Inflammatory Stress Indexes

Objective:To compare the therapeutic effect of nasal endoscopic anterior lacrimal recess approach and nasal endoscopic fenestration of middle and lower nasal sinuses in the treatment of maxillary sinus inverted papilloma with Kruse grade T2 and T3 and its influence on inflammatory stress indexes.Methods:The clinical data of 50 patients with inverted papilloma of maxillary sinus were retrospectively analyzed.They were divided into group A(n=26,nasal endoscopic fenestration of middle and lower nasal sinuses)and group B(n=24,nasal endoscopic anterior lacrimal recess approach).The perioperative indexes,inflammatory stress indexesinterleukin-8(IL-8),interleukin-10(IL-10),procalcitonin(PCT)],complications and recurrence rate of the two groups were investigated.Results:Compared with the group A,the group B had less intraoperative blood loss,shorter operation time,postoperative nasal wound healing time,shorter hospital stay,and less postoperative pain,and the differences were statistically significant(P<0.05).The levels of IL-8 and PCT before operation,1 d and 10 d after operation in the two groups were firstly increased and then decreased,IL-10 decreased first and then increased(P<0.025),and the levels of IL-8 and PCT in the group B on 1 d after operation were lower than those in the group A,IL-10 levels was higher than that in group A(P<0.05).There was no significant difference in the incidence of complications and postoperative recurrence between the two groups(P>0.05).Conclusion:The treatment of maxillary sinus inverted papilloma with Krouse grading T2 and T3 through nasal endoscopic anterior lacrimal recess approach has the advantages of less trauma,faster postoperative recovery,less inflammatory stress and less postoperative complications.It is one of the better surgical methods for maxillary sinus inverted papilloma.