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目的探讨和完善鼻内镜下彻底切除鼻腔、上颌窦内占位性病变,降低术后复发率的手术方法。方法回顾分析1999年1月至2008年12月在我院经泪道置管联合鼻内镜行上颌窦内壁扩大切除术治疗的上颌窦占位性病变且随访资料完整的69例的临床资料。术中先行泪道置管,并应用动力系统切除鼻腔内瘤体,切除上颌窦内壁大部,在30°镜下于肿瘤基底部周围骨膜下剥离肿瘤,局部骨骼化,用电刀烧灼基底部残余软组织,以防止复发,术后长期随访。结果患者均在鼻内镜下随访。1例鼻内翻性乳头状瘤患者于术后4个月复查时发现后组筛窦内复发,咬除肿物后用电刀烧灼,随访至今未见复发。1例淋巴瘤术后半年死于广泛转移。其余67例经随访1~9年,未见复发,无溢泪及其他并发症,治愈率为97.10%。鼻内翻性乳头状瘤患者与对照组行Caldw ell-Luc手术或鼻侧切开术治疗相比较,治愈率差异有统计学意义(P<0.05)。结论在正确选择适应证的前提下,泪道置管联合鼻内镜下上颌窦内壁扩大切除术可有效切除上颌窦占位性病变,可作为上颌窦占位性病变的首选术式。
Objective To explore and improve the method of radical resection of nasal cavity and maxillary sinus space occupying lesion under nasal endoscope and reduce the recurrence rate. Methods From January 1999 to December 2008 in our hospital through the lacrimal duct catheterization combined endoscopic maxillary sinus resection of maxillary sinus space-occupying lesions and follow-up data of 69 cases of complete clinical data. Intraoperative lacrimal duct catheterization, and the application of dynamic removal of intranasal tumor, resection of most of the maxillary sinus wall, in 30 ° under the microscope around the basal part of the periosteal stripped tumor, local bone, with the electric knife burning base Remnants of soft tissue to prevent recurrence, long-term follow-up. Results All patients underwent endoscopic sinus surgery. One case of nasal inverted papilloma was found in the posterior ethmoid sinus recurrence 4 months after the operation. After bite removal of the tumor, cauterization was performed with an electric knife, and no recurrence was observed up to now. One case of lymphoma died of extensive metastasis six months after operation. The remaining 67 cases were followed up for 1 to 9 years, no recurrence, no tears and other complications, the cure rate was 97.10%. In patients with nasal inverted papilloma treated with Caldwell ell-Luc surgery or nasal surgery, the difference was statistically significant (P <0.05). Conclusion In the correct choice of indications, under the premise of lacrimal duct catheterization combined with nasal endoscopic maxillary sinus wall resection can effectively remove the space-occupying lesions of maxillary sinus can be used as the first choice of maxillary sinus space-occupying lesions.