鼻内镜下经上鼻道径路处理孤立性蝶窦病变

目的探讨鼻内镜下处理孤立性蝶窦病变的方法及疗效。方法回顾分析1999年8月~2004年10月93例孤立性蝶窦病变病人在鼻内镜下经上鼻道径路行孤立性蝶窦病变处理。鼻内镜下切除上鼻甲后半部分,直接暴露蝶窦前壁及开口,扩大开口,处理蝶窦病变。结果所有病例均顺利完成手术,无1例发生严重并发症。随访1~2年,蝶窦炎、蝶窦脓肿、蝶窦黏液囊肿、真菌性蝶窦炎、蝶窦息肉等88例病人均无复发。其余5例病人中1例真菌性蝶窦炎术后不久侵入颅内,后经抗真菌及综合治疗痊愈;2例蝶窦顶后壁脑脊液鼻漏1次性修补成功;1例蝶窦侧壁脑脊液鼻漏修补失败;1例蝶窦血管瘤未愈。结论鼻内镜下经上鼻道进路是处理孤立性蝶窦病变安全、直接、微创、有效的治疗方法。

Treament of isolated sphenoid sinus diseases via trans-superior meatus approach under endoscope

Objective To explore the operative method and the therapeutic effect of isolated sphenoid sinus diseases under endoscope.Methods Ninety-three patients suffering from isolated sphenoid sinus diseases received surgical treatment via trans-superior meatus approach under endoscope from August 1999 to October 2004,and their clinical data were ananlyzed retrospectively.The surgical procedures included exposure of the anterior wall and ostium of sphenoid sinus by direct transnasal superior turbinectomy under endoscope and then widening of the ostium followed by management of focus.Results All 93 cases were successfully operated without serious complications.In 88 cases of sphenoidal sinusitis,sphenoid sinus abscess and mucoceles and mycosis,sphenoid sinus polyp,no recurrence was found.In other 5 cases,infection diffused into cranial cavity shortly after operation in one case of mycosis was cured later by anti-fungus and synthetical treatment.Postoperative cerebrospinal rhinorrhea occured in 3 cases,2 cases were cured and 1 case failed.One case of sphenoid sinus hemangioma was not cured.Conclusion Treatment of isolated sphenoid sinus diseases via trans-superior meatus under endoscope is a safe,direct,minimally invasive,and effective method.