论文部分内容阅读
目的报告经鼻完成鼻腔外侧壁切开并保留鼻泪管和下鼻甲,进入上颌窦的新方法及临床初步应用结果,并就手术方法和适应证进行探讨。方法 12例住院手术患者,男9例,女3例;年龄42～68岁。术前或术中组织病理学确诊为上颌窦内翻性乳头状瘤8例,鼻息肉2例,复发性上颌骨囊肿1例,上颌窦根治术后囊肿1例。2例肿瘤患者因随访少于12个月不计入疗效评定。所有患者术前接受鼻内镜及鼻窦 CT 扫描检查。6例肿瘤患者同期行鼻窦 MRI 检查。手术在全麻下进行。方法为在下鼻甲头端鼻腔外侧壁切开,解剖出鼻泪管后形成鼻泪管-下鼻甲瓣,内移后形成上颌窦入路,在鼻内镜直视下完成窦内病灶清除。术终复位下鼻甲和鼻泪管并完成下鼻道开窗。结果 10例患者均为单侧发病,6例上颌窦内翻性乳头肿瘤 Kmuse 分期均为 T3。术中见肿瘤起源于上颌窦,各壁均受累,前、内壁明显。2例鼻息肉累及上颌窦各壁。术后随访7～60个月,平均22个月,术腔上皮化,下鼻甲形态良好。1例术后6个月下鼻道上颌窦开窗口局部复发,局部清创后无复发。10例术后无溢泪等并发症。结论经鼻腔外侧壁切开并保留鼻泪管和下鼻甲进入上颌窦,为彻底切除上颌窦病灶及经上颌窦进入眶底和翼腭窝等提供一新的微创入路和方法。
Objective To report the nasal lacrimal duct and inferior turbinate, the new method of entering the maxillary sinus and the preliminary clinical application results through nasal nasal lateral wall, and discuss the surgical methods and indications. Methods 12 cases of hospitalized patients, 9 males and 3 females; aged 42 to 68 years. Eight cases of maxillary sinus inverted papilloma, two cases of nasal polyps, one case of recurrent maxillary cyst and one case of maxillary sinus gastrectomy were diagnosed preoperatively or intraoperatively. 2 patients with cancer due to follow-up less than 12 months not included in the evaluation of the effect. All patients underwent endoscopic sinus surgery and CT scan. 6 cases of cancer patients underwent sinus MRI examination at the same period. Surgery under general anesthesia. Method is in the inferior turbinate head nasal lateral wall incision, the dissection of the nasolacrimal duct after the formation of nasolacrimal duct - inferior turbinate flap, the formation of the maxillary sinus approach after the endoscopic sinus surgery to complete the removal of lesions. End of the surgery to restore the inferior turbinate and nasolacrimal duct and the completion of the next nasal opening. Results All 10 patients had unilateral disease. The Kmuse stages of the maxillary sinus inverted papillary tumors were all T3. Surgery, see the tumor originated in the maxillary sinus, the walls are involved, the former, the inner wall was obvious. 2 cases of nasal polyps involving the maxillary sinus wall. The patients were followed up for 7 to 60 months with an average of 22 months. The epithelium of the cavity and the inferior turbinate were well established. One case of 6 months after the operation of the nasal sinus maxillary sinus open local recurrence, no recurrence after local debridement. Ten cases had no complications such as overflow of tears after operation. Conclusions The nasolacrimal duct and inferior turbinate can be dissected through the lateral wall of the nasal cavity and enter the maxillary sinus. This provides a new minimally invasive approach to the complete removal of maxillary sinus lesions and maxillary sinus into orbital floor and pterygopalatine fossa.