Author/Editor		Spudič, Štefan; Podboj, Jernej; Boršoš, Imre
Title		Endoskopska kirurgija invertiranega papiloma
Translated title		Endoscopic surgery of inverted papilloma
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 7, št. 16-17
Publication year		2002
Volume		str. 29-35
Language		slo
Abstract		Background. Inverted papillomas of the nose and paranasal sinuses are very common benign lesions, characterised by their tendency to recur and by their high malignant transformation potential. Primary radical resection is mandatory in these cases. In the majority of patients with inverted nasal papillomas, standard surgical extranasal resection is successfully replaced by endoscopic treatment. Patient and methods. At the Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, 35 patients with inverted papillomas were operated on between 1989 and 2001. After endoscopic and radiologic evaluation of the extent of the tumor growth we decided for the endoscopic approach in 20 patients, for extranasal en bloc resection in 12 patients, and for a combination of both techniques in 3 patients. Results. The overall recurrence rate was 20% and the rate of malignant transformation 6%. The recurrence rate varied from 13% for patients operated on classically to 25% for patients treated by endoscopic surgery. In the last 5 years, the recurrence rate in patients treated by the endoscopic approach fell to 14%. Conclusions. Aggressive initial eradication of the disease remains the therapeutic goal in the management of inverted papillomas. In the hands of experienced and skilled rhinosurgeons endoscopic radical resection is just as efficient and safe as external surgery.
Summary		Izhodišča. Invertirani papilom je najpogostejši benigni tumor nosu in obnosnih votlin, ki ponavadi zraste na lateralni steni srednjega nosnega hodnika in ekspanzivno-destruktivno vrašča v okolico. Zaradi možnosti recidiva in malignizacije je pomembna primarna korenita odstranitev. Namesto klasičnih kirurških pristopov se vse bolj uveljavlja endoskopska resekcija invertiranega papiloma. Bolniki in metode. Od leta 1989 do 2001 smo na Kliniki za otorinolaringologijo in cervikofacialno kirurgijo v Ljubljani operirali 35 bolnikov z invertiranim papilomom. Po oceni razširjenosti tumorja na osnovi endoskopskega pregleda in računalniškega tomografskega slikanja obnosnih votlin, smo 20 bolnikov operirali endoskopsko, 12 bolnikov s klasičnim pristopom, pri 3 pa smo endoskopski pristop spremenili v klasičnega. Rezultati. Invertirani papilom je recidiviral pri 7 (20%) operiranih bolnikih in sicer pri 5 do 20 endoskopsko operiranih (25%) in pri 2 do 15 klasično oziroma kombinirano operiranih (13%). Pri 2 bolnicah (6%) smo po 7 in 16 letih ob recidivu papiloma ugotovili in s klasičnim pristopom odstranili planocelularni karcinom. Zaključki. Ključ uspeha operativnega zdravljenja invertiranega papiloma je primarna radikalna odstranitev tumorja. Endoskopska korenita odstranitev invertiranega papiloma je v rokah izkušenega rinokirurga enako učinkovita in varna kot resekcija z uporabo klasičnega pristopa.
Descriptors		NOSE NEOPLASMS PAPILLOMA, INVERTED SURGERY, ENDOSCOPIC TREATMENT OUTCOME