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目的探讨包括骨瘤、骨化纤维瘤、骨纤维异常增殖症在内的累及鼻颅底区域鼻腔鼻窦骨源性良性肿瘤鼻内镜手术治疗策略。方法经鼻内镜治疗鼻腔鼻窦骨源性良性肿瘤140例,包括骨瘤116例,骨化纤维瘤14例,骨纤维异常增殖10例。手术方式包括:单纯鼻内镜手术95例,影像导航辅助鼻内镜手术24例,鼻内镜联合鼻外入路21例。结果患者均顺利完成手术,未发生严重并发症。骨瘤均彻底切除。骨化纤维瘤12例得到彻底切除,2例有病变残留。骨纤维异常增殖症10例采取姑息性手术,术后面部外观得以恢复,病变对周围组织地压迫症状得以缓解。术后随访6~36个月,骨瘤术后无复发,骨化纤维瘤术后复发2例,骨纤维异常增殖症1例术后视力无改善,其余患者症状得到不同程度的缓解。结论骨瘤、骨化纤维瘤及骨纤维异常增殖是鼻窦常见的良性纤维骨性病变。三者临床症状相似。高分辨率CT和(或)MRI是早期诊断的重要手段。影像导航引导鼻内镜并必要时联合鼻外入路手术是治疗该类疾病的有效方法。手术时机及手术方式的选择应依据病变类型、患者症状、肿瘤位置及范围综合考虑。
Objective To investigate the treatment of nasal endoscopic sinus surgery involving nasal sinus and benign bone tumors in nasal skull base including osteoma, osteofibroma, and fibrous dysplasia. Methods Nasal endoscopic sinus surgery for nasal benign bone tumors in 140 cases, including 116 cases of osteoma, ossification of fibroids in 14 cases, 10 cases of abnormal bone fiber proliferation. Surgical methods include: simple endoscopic sinus surgery in 95 cases, video navigation assisted endoscopic surgery in 24 cases, endoscopic nasal approach in 21 cases. Results All patients successfully completed the operation without serious complications. Osteoma were completely removed. Ossified fibroids in 12 cases were completely resected, 2 cases of residual disease. 10 cases of fibrous dysplasia were treated with palliative surgery, facial appearance was restored, the lesion on the surrounding tissue compression symptoms can be alleviated. Postoperative follow-up 6 to 36 months, no recurrence of osteoma after operation, 2 cases of ossification fibroids recurrence after surgery, 1 case of dysplasia of fibroids no improvement of visual acuity, the rest of the patients were relieved to varying degrees. Conclusion Osteoma, osteofibroma and abnormal proliferation of bone fibers are common benign fibrous bony lesions in sinus. The three clinical symptoms are similar. High-resolution CT and / or MRI are important tools for early diagnosis. Navigating the nasal endoscope with video guidance and, if necessary, combining the nasal approach is an effective method of treating this condition. The timing of surgery and the choice of surgical approach should be based on the type of lesion, the patient’s symptoms, the location and extent of the tumor.