鼻・副鼻腔乳頭腫に対する鼻内内視鏡手術

抄録

Between July 2004 and December 2007, 15 patients with sinonasal papilloma were surgically treated at the Department of Otolaryngology, Saitama Medical Center, Jichi Medical University. All patients underwent endonasal sinus surgery (ESS) under general anesthesia. In preoperative imaging diagnosis, MRI was useful for evaluating the extent of tumor growth, and CT was useful for determining the presence or absence of osteolysis. In principle, ESS consisted of opening of the ethmoidal sinus, followed by resection of the membranous portion containing the lesion, and opening of the maxillary sinus. When the tumor base was located in the ethmoidal/maxillary sinus, extensive resection of the tumor and the surrounding normal mucosa was performed. When resection via the membranous portion alone was impossible due to tumor growth anterior to the maxillary sinus, after confirmation of the opening of the nasolacrimal duct, the inferior nasal meatus was opened, as much as possible, and manipulation via the inferior nasal meatus was also performed. The nasolacrimal duct, including the opening, was preserved. A microdebrider was used in all patients. No recurrence has been observed to the present in 11 of 14 patients who underwent total resection of the tumor. The other 3 patients with recurrence underwent ESS again under local anesthesia and have shown no recurrence to the present. In remaining 1 patient, preoperative CT showed osteolysis, and squamous cell carcinoma as a complication was suspected. However, since the endonasal biopsy at the outpatient clinic did not facilitate a definite diagnosis, ESS was performed mainly for pathological examination, and a diagnosis of squamous cell carcinoma was made. Subsequently, this patient underwent cranial base surgery in another institution. Since importance has been attached to functional surgery in recent years, ESS for sinonasal papilloma meets the demands of the times.