内镜下鼻腔泪前隐窝-上颌窦入路切除翼腭窝肿瘤

目的 探讨内镜经鼻腔泪前隐窝-上颌窦入路在翼腭窝病变手术中的应用.方法 回顾性分析2008年5月至2011年5月5例翼腭窝良性肿瘤患者的病例资料,5例患者均接受了内镜经鼻腔泪前隐窝-上颌窦入路的外科治疗.其中神经鞘瘤4例,神经纤维瘤1例.手术采用控制低血压全身麻醉,鼻内镜下泪前隐窝入路切开鼻腔外侧壁进入上颌窦,切开上颌窦后壁进入翼腭窝切除肿瘤.结果 本组5例肿瘤均获得一次性完全切除,无任何并发症.均于术后5～12 d痊愈出院.术后随访5～28个月无复发和死亡.结论 内镜经鼻腔泪前隐窝-上颌窦入路可以安全而完整地切除翼腭窝的良性肿瘤.该术式保留了鼻泪管和下鼻甲,保留鼻腔结构和功能,从而更好地降低复发率和缩短恢复时间.

Endoscopic transnasal prelacrimal recess-maxillary sinus approach for tumors in the pterygopalatine fossa

Objective To explore the application of endoscopic transnasal prelacrimal recessmaxillary sinus approach in surgery for lesions in the pterygopalatine fossa.Methods Five patients with tumors of pterygopalatine fossa were treated by endoscopic transnasal prelacrimal recess-maxillary sinus surgery between May 2008 and May 2011.The lesions treated included 4 schwannoma and 1 neurofibroma.The operation began with endoscopic transnasal lateral nasal wall approach to maxillary sinus.Then after opening posterior wall of maxillary sinus,the pterygopalatine fossa was entered and the tumor was removed.The operation was performed under hypotension anaesthesia.Results The tumors were removed totally in all 5 patients.No complication was found.After the surgery,all patients fully recovered and were discharged from the hospital in 5 to 12 days.No recurrence and death occurred during the follow up periods ranging from 5 to 28 months.Conclusions Endoscopic transnasal prelacrimal recess-maxillary sinus approach is safe and effective management for benign tumors in the pterygopalatine fossa.This approach reserved nasolacrimal duct and turbinate,maintained the structure and function of the nose,with decreased morbidity and shorter recovery periods.