慢性鼻-鼻窦炎鼻息肉内镜手术严重并发症分析

目的探讨慢性鼻-鼻窦炎鼻息肉内镜手术严重并发症的分类、发生率及其影响因素，以期从中获得启示。方法对随访资料完整的1102例（1769侧）慢性鼻一鼻窦炎鼻息肉患者内镜手术发生21例次严重并发症的情况进行总结、分析。结果21例次严重并发症包括：眶内血肿3例次、眼内直肌损伤2例次、视力丧失1例次、颅内血肿1例次、脑脊液鼻漏3例次、鼻泪管阻塞3例次、鼻中隔穿孔2例次、大出血2例次、下肢血栓形成2例次、术后哮喘发作2例次。严重并发症的发生率为1．91％（21／1102），其中眼部并发症（0．54％）和颅内并发症（0．36％）发生率较高。患者的病变范围、前期手术史和术者的手术经验及技巧是影响严重并发症发生率的重要因素。结论导致鼻内镜手术严重并发症的因素众多，然而主观因素比客观因素起更大的影响作用，其中以术者的手术经验尤为重要。

Severe complications in the treatment of chronic rhinosinusitis and nasal polyps with endoscopic sinus surgery

OBJECTIVE: To investigate the classification, incidence and influential factors of severe complications occurred in endoscopic sinus surgery (ESS) and how to deal with them. METHODS: One thousand and one hundred two patients with chronic sinusitis and nasal polyps treated by ESS were analyzed. RESULTS: Twenty-one patients had severe complications. The types of complication included intraorbital hematoma (n=3), medial rectus injury (n=2), blindness (n=1), intracranial, hematoma (n=1), cerebrospinal rhinorrhea (n=3), nasolacrimal duct injury (n=3), nasal septum perforation (n=2), hemorrhage (n=2), thrombosis in legs (n=2) and asthma (n=2). The total incidence of severe complications was 1.91% (21/1102), most of which were complications in orbit (0.54%) and cranium (0.36%). The extent of the lesion, the surgical history of the patients, the technique and experience of the surgeons were the most important influential factors to severe complications. CONCLUSIONS: Although there are many influential factors to severe complications in ESS, subjective factors are the more important, especialy, the technique and the experience of the surgeon.