【摘要】
   目的：探讨额窦及额隐窝内翻性乳头状瘤鼻内镜手术技术及疗效。
   材料和方法：年龄16-76岁（平均47.5岁）经组织病理学检查证实的累及额隐窝及额窦的复发内翻性乳头状瘤24例，女性4例，男性20例。手术前主要接受鼻窦CT扫描和MRI。所有病例采用经鼻内镜手术，手术方式为Draf IIb或Draf III（改良经鼻内镜Lothrop手术），2例结合额窦微钻孔。随访8-72个月（平均33.7个月）。
   结果：18例有1次前期手术，6例有2次以上手术史。前期手术包括鼻侧切开术（4例），经鼻手术（2例），柯陆氏手术 1例。有16例接受了鼻内镜手术。鼻窦CT扫描和MRI显示额隐窝和额窦受累，7例双侧额窦受累，3例同时累计筛窦和上颌窦。7例有明显新骨形成或骨质破坏。5例诉鼻塞，14例有脓涕，其中4例涕中带血。15例有持续或间歇性头痛，4例无症状，仅在随访中发现复发。3例接受Draf IIb，14 例行扩大Draf IIb，7例行Draf III手术；其中6例同期行上颌窦和筛窦手术。2例分别在手术6个月和15个月局部复发，组织病理提示恶变，再行Draf IIb后无复发。
   结论：结合专用额窦器械，复发额隐窝及额窦内翻性乳头状瘤在熟练手术技术和严格适应证基础上，采用 Draf II到Draf III手术方法，或可结合额窦钻孔，可以彻底切除。
【关键词】内翻性乳头状瘤；复发；额隐窝；鼻内镜；手术

Endoscopic Management of
Recurrent Inverted Papilloma of Frontal Recess
Bing ZHOU, De-min HAN, Luo ZHANG, Hua-chao LIU, Shun-jiu CUI, Qian HUANG, Ming LIU. Department of Otolaryngology- Head and Neck Surgery, Beijing Tongren Hospital Affiliated to the Capital Medical University, Beijing, 100730, China
Corresponding author: Bing ZHOU, E-mail:entzhou@263.net

Abstract
Objective: To explore the operative methods for recurrent inverted papilloma of frontal recess (RIPFR) and the possibility of intranasal endoscopic surgery and its key technique points.
Methods: 24 cases of RIPFR, aged from 16-76 year-old (mean, 47.5 year-old) were included in this study. 20 were male and 4 were female. Paranasal sinus CT scan and MRI were did for these patients preoperatively. Inverted papilloma was confirmed by histopathologic examination postoperatively. All patients were management endoscopically with Draf II or Draf III (modified Lorthop procedure, MLP) under general anesthesia combined with or without minitrephine. The follow-up period ranged from 8 to 72 months (mean, 33.7 month).
Results: The prior operations included lynch procedure (4 cases), endonasal operation (2 cases), Caldwell-Luc operation (1 case) and endoscopic sinus surgery (16 cases). Among 24 cases, 18 cases had one prior operation, 6 case had more than 2 prior operative experiences. Paranasal sinus CT and MRI demonstrated that the frontal recess and sinus of all cases was involved. 7 cases of frontal sinus were involved bilaterally and the ethmoid and maxillary sinus were involved in 3 cases. Neoosteogenesis and bone erosion or destroyed were seen in 7 cases. 5 cases had nasal obstruction. Purulent discharge was in 14 cases. 4 patients had mucoid discharge with blood. Persistent or intermittent headache were encountered in 15 cases. 4 cases had no symptoms and were found tumor recurrent during follow-up. 3 patients had undergone Draf IIa , 14 cases Draf IIb and 7 Draf III (MLP). 6 cases conceived ethmoidectomy and antrostomy simultaneously. 2 patients, who had a local recurrence six or 15 months after operation, had an evidence of canceration. They experienced the second Draf IIb and no recurrence was happened until now.
Conclusions: Combined with special instruments for frontal sinus, the RIPFR with or without invasion of frontal sinus could be dissected on the basis of proper indications and well-trained skill. Draf IIb-III with or without minitrephine should be a good selection.

Keywords: Inverted papilloma; Recurrence; Frontal recess; Nasal endoscope; Surgery