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Recurrence rates according to surgical approaches for treating the sinonasal inverted papillomas

Other Titles
 비·부비동 반전성 유두종에서 수술 방법에 따른 재발률 
Authors
 김원식 
Department
 Dept. of Otorhinolaryngology (이비인후과학교실) 
Issue Date
2010
Description
의학과/석사
Abstract
[한글]내시경적 접근법이 발달하기 이전에는 수술 후 재발을 잘 하는 비·부비동 반전성 유두종의 특성상 lateral rhinotomy 접근에 의한 medial maxillectomy가 수술적 치료의 근간이 되었다. 그러나 이 같은 접근법은 안면에 흉터를 남기는 단점이 있었으며, midfacial degloving 접근법과 같이 흉터가 남지 않는 방법이 대두되었다. 1990년대 초반 반전성 유두종의 치료에서 내시경적 접근법이 소개된 이후 현재에는 가장 널리 사용되는 치료법으로 자리잡았다. 그러나 각각의 접근법에 대해서는 아직까지 논쟁의 여지가 있다. 본 연구에서는 후향적 의무기록 조사를 통해 내시경적 접근법, lateral rhinotomy 접근법, midfacial degloving 접근법의 각 stage에 따른 재발률을 비교, 분석하였다. 총 114명의 환자(남자 82명, 여자 32명)가 치료 받았으며, 평균 연령은 51.0세이었다. 추적 관찰 기간은 8개월에서 12년까지이고, 평균 추적 관찰 기간은 2.9년이었다. 전체 재발율은 23.7% (27/114)이고, 내시경적 치료를 받은 환자군은 84명 (73.7%)으로 재발률은 27.4%이었다. Midfacial degloving approach로 치료를 받은 환자군은 21명 (18.4%)으로 재발률은 9.5%이었다. Lateral rhinotomy approach로 치료를 받은 환자군은 9명 (7.9%)으로 재발률은 22.2%이었다. Krouse stage I 인 환자는 11명 (9.6%), Krouse stage II 인 환자는 50명 (43.9%), Krouse stage III 인 환자는 53명 (46.5%) 이었다. Krouse stage III 인 환자군 중에서 23명이 내시경적 접근법으로 수술을 받았으며 이 중 9명 (33.3%)이 재발하였고, 18명은 midfacial degloving approach로 수술을 받았고 이 중 2명 (11.1%)이 재발하였으며, 8명은 lateral rhinotomy approach로 수술을 받아 이 중 2명 (25.0%)이 재발하였다. Krouse stage III 인 환자군에서 midfacial degloving approach로 수술을 받은 환자군에서 다른 접근법으로 수술을 받은 환자군보다 비록 통계학적으로 유의미하지는 않으나 재발률이 더 낮았다. Midfacial degloving approach는 advanced stage의 반전성 유두종 치료에 있어서 lateral rhinotomy appraoch와 비교해 볼 때 안면의 흉터를 남기지 않으면서도 재발률 면에서 큰 차이를 보이지 않는 수술적 접근법의 한 대안이 될 수 있을 것이다.
[영문]Before the advent of the endoscopic era, most surgeons recommended medial maxillectomy via lateral rhinotomy in the treatment of advanced cases of inverted papilloma due to its tendency to recur following excision. However, permanent facial scarring is a major drawback of the lateral rhinotomy approach. In addition to the lateral rhinotomy approach, the midfacial degloving approach is a scarless alternative for managing advanced inverted papilloma. In the early 1990s, an endoscopic approach for the treatment of inverted papilloma was introduced and became the standard choice for surgical treatment. However, controversy still exists over which surgical approach should be used, the endoscopic method vs. the external method. In this study, we compared recurrence rates in patients treated with the endoscopic approach, midfacial degloving approach, and lateral rhinotomy approach by retrospective review of medical records of patients in each Krouse stage1 of inverted papilloma. One hundred and fourteen patients (82 males, 32 females) with an average age of 51.0 years were diagnosed and treated surgically for inverted papilloma. The follow-up period ranged from 10 months to 12 years (mean, 2.8 years). The overall recurrence rate was 23.7% (27/114). The endoscopic approach was completed in 84 patients (73.7%), with a recurrence rate of 27.4%, while the medial maxillectomy with the midfacial degloving approach was used to treat 21 patients (18.4%), who had a recurrence rate of 9.5%. The medial maxillectomy with the lateral rhinotomy approach was completed in 9 patients (7.9%), with a recurrence rate of 22.2%. Eleven patients (9.6%) were classified as Krouse stage I, 50 patients (43.9%) as Krouse stage II, and 53 patients (46.5%) as Krouse stage III. None of the patients in this study were classified as Krouse stage IV. Among the patients classified with Krouse stage III, 27 patients were treated with the endoscopic approach and nine of these patients (33.3%) had recurrences. Eighteen patients were treated with the midfacial degloving approach and two of these patients (11.1%) had recurrences. Eight patients were treated with the lateral rhinotomy approach and two of these patients (25.0%) had recurrences. Among the patients classified with Krouse stage III, inverted papilloma had a lower risk of recurrence with midfacial degloving than with the endoscopic or lateral rhinotomy approaches, although this difference was not statistically significant (p = 0.310). Thus, for treating advanced inverted papilloma, the midfacial degloving approach is an alternative strategy with a fair recurrence rate, and is an approach that can replace the potentially scarring lateral rhinotomy approach.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Otorhinolaryngology (이비인후과학교실) > 2. Thesis
Yonsei Authors
Kim, Won Shik(김원식)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/124770
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