鼻内镜下手术治疗侵及眼眶的鼻腔鼻窦肿瘤

目的： 探讨鼻内镜下手术治疗侵及眼眶的鼻腔鼻窦肿瘤的安全性、临床效果和术式的选择。方法:回顾性分析15例在鼻内镜下行切除手术治疗的侵及眼眶的良性和早期恶性鼻腔鼻窦肿瘤患者的临床资料、手术方法、并发症及治疗预后。结果:全部病例中,11例单纯经鼻内镜下切除肿瘤，4例经鼻腔和鼻外切口双径路手术治疗，其中 1例侵袭性大B细胞淋巴瘤患者术后出现下睑外翻，经治疗后好转；1例鼻腔鼻窦骨瘤患者于鼻内镜下全切骨瘤，术后出现患侧内眦外移；4例良性骨源性病变患者行鼻内镜下病变部分切除术，其余病例均彻底切除肿瘤而无明显并发症，随访6~36月未见复发。结论:鼻内镜下手术治疗侵及眼眶的鼻腔鼻窦肿瘤有其独特的优势，在鼻内镜下单纯经鼻腔或内镜辅助经鼻腔和鼻外切口双径路手术治疗可以取得比较好的临床预后。

The Treatment of Sinonasal Tumors with Orbital Invasion by Endoscopic Endonasal Surgery

Objective:To investigate the safety,clinical effectiveness and the choices of operation methods of endoscopic surgery for sinonasal tumors with orbital invasion.Methods:The clinical data,operation methods,complication and treatment outcomes of 15 patients of benign and early stage malignant sinonasal tumors with orbital invasion treated with endonasal endoscopic surgery were analyzed retrospectively.Results:In all cases,11 patients underwent endonasal endoscopic resection of the tumor,4 cases underwent endoscopic dual approach surgery with endonasal and external nasal incision,of which 1 case of aggressive large B cell lymphoma patient had postoperative lower eyelid ectropion,1 case of sinonasal osteoma resected completely and left ipsilateral inner canthus displacement postoperatively;4 cases of benign bone lesions were treated with endoscopic partial excision of lesion,the tumor of the remaining cases were completely resected without significant complications,and followed up for 6 to 36 months without recurrence.Conclusion:Endoscopic surgery for the treatment of sinonasal tumors with orbital invasion had unique advantages,the better clinical outcome could be achieved through simple endonasal endoscopic surgery or the dual approach surgery with endonasal and external nasal incision assisted with endoscope.