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目的:探讨鼻内镜下鼻腔外侧壁切开入路治疗难治性复发性上颌窦良性病变的手术方法和临床价值。方法:回顾分析8例上颌窦筛窦手术后复发病例,其中男性6例,女性2例,年龄41～69岁,平均(55±14)岁,先前均有2～4次手术史。本次手术在全麻下进行,先从下鼻甲前缘行鼻腔外侧壁切开,解剖出鼻泪管后形成鼻泪管-下鼻甲瓣,内移形成上颌窦入路,然后在鼻内镜直视下彻底清除上颌窦病灶,最后复位鼻泪管-下鼻甲黏膜瓣,必要时行下鼻道开窗。术后均行病理排查。结果:所有患者术后均经病理证实为良性病变,排除恶性肿瘤。于术后6个月进行评价,5例治愈,3例好转。随访6～14个月均无面颊部麻木、溢泪、眶内出血、视物障碍或脑脊液鼻漏等并发症。结论:鼻内镜下鼻腔外侧壁切开入路上颌窦手术视野宽,有利于整个上颌窦腔病变彻底清除,保留了鼻泪管和下鼻甲,临床疗效满意。
Objective: To explore the surgical methods and clinical value of nasal endoscopic nasal lateral wall incision in the treatment of refractory recurrent benign maxillary sinus disease. Methods: Retrospective analysis of 8 cases of maxillary sinus ethmoid sinus surgery recurrence cases, including 6 males and 2 females, aged 41 to 69 years, mean (55 ± 14) years of age, previously had 2 to 4 surgeries. The operation under general anesthesia, first from the inferior turbinate front nasal cavity lateral wall incision, dissecting the nasolacrimal duct after the formation of nasolacrimal duct - inferior turbinate flap, shift the formation of the maxillary sinus approach, and then endoscopic straight Depending on the maxillary sinus lesions removed completely, and finally reset the nasolacrimal duct - inferior turbinate mucosal flap, if necessary, under the line of the nose to open the window. Postoperative pathological examination. Results: All patients were pathologically confirmed as benign lesions, excluding malignant tumors. Six months after surgery, 5 cases were cured and 3 cases improved. No complications such as numbness of face, overflow of tears, orbital bleeding, visual disturbances or cerebrospinal fluid rhinorrhea occurred in 6-14 months follow-up. Conclusion: The wide field of vision of the maxillary sinus under endoscopic nasal lateral wall incision is helpful for the complete removal of the maxillary sinus lesion and the retention of nasolacrimal duct and inferior turbinate. The clinical curative effect is satisfactory.