经鼻内镜泪前隐窝入路上颌窦手术的临床疗效

目的研究经鼻内镜泪前隐窝入路手术彻底切除上颌窦病变的临床应用效果。方法收集2008年8月至2016年8月采用经鼻内镜泪前隐窝入路治疗107例上颌窦内的息肉、囊肿、真菌、良性及恶性肿瘤病变的临床资料。其中鼻内翻乳头状瘤28例、上颌窦炎伴囊肿24例、复发性真菌20例、出血坏死性息肉17例、上颌窦骨瘤6例、上颌窦含牙囊肿5例、上颌窦鳞状细胞癌4例,上颌骨囊肿3例。所有患者术前均行CT检查,手术先切除鼻腔和其他鼻窦病变,开放并扩大上颌窦自然窦口,再行泪前隐窝入路切除上颌窦病变,术后肿瘤患者行下鼻道开窗。结果全部患者均能良好显露上颌窦各壁,彻底切除病变组织、无面部麻木、溢泪、眼眶青紫、视物模糊、鼻腔干燥等并发症。非肿瘤患者随访3~6个月、肿瘤患者术后一直随访。内翻乳头状瘤有4例复发,3例术后1~2年上颌窦口附近复发,经局部切除后随访3~5年未再发,另1例术后6个月中鼻甲残端处局部复发,再次手术切除病灶及中鼻甲,随访3年,未见复发。其余患者均未见复发。所有患者术后临床症状逐渐消失,下鼻甲形态良好,上颌窦腔上皮化。结论经鼻内镜泪前隐窝入路手术能够充分显露上颌窦腔,彻底切除上颌窦前内下壁及窦腔内的病变,手术操作方便,并发症少,术后观察方便,疗效满意,值得推广。

Clinical efficacy of Endoscopic Transnasal Lacrimal Fossa Approach for Maxillary Sinus Surgery

Objective To study the clinical effect of endoscopic sinus surgery for the complete resection of maxillary sinus lesions by anterior lacrimal fossa approach.Methods From August 2008 to August 2016,the clinical data of 107 cases of maxillary sinus polyps,cysts,fungi,benign and malignant tumors treated by endoscopic transnasal lacrimal fossa approach were collected,of which 28 cases of nasal inverted papilloma,24 cases with maxillary sinus cyst,20 cases of recurrent fungal,17 cases of hemorrhagic and necrotic polyps,6 cases of maxillary sinus osteoma,5 cases of dentigerous cyst of maxillary sinus,4 cases of squamous cell carcinoma of the maxillary sinus,3 cases of maxillary cyst. CT examination was performed in all patients before surgery. After the removal of nasal cavity and other sinus lesions,the natural sinus ostium of maxillary sinus was opened and expanded.Then the anterior lacrimal fossa approach was performed to remove the maxillary sinus lesions.Patients with tumor after surgery underwent fenestration through the lower nasal meatus.Results The wall of maxillary sinus could be revealed in all patients well and the diseased tissue could be completely removed without facial numbness,tears,cyanosis,blurred vision,dry nose and other complications. The non-tumor patients were followed up for 3 ~ 6 months,while the tumor patients were followed up postoperatively.Inverted papilloma recurred in 4 cases,of which 3 cases recurred near the maxillary sinus at 1 ~ 2 year after operation and after local excision they were followed up for 3 ~ 5 years without recurrence.And the left 1 case had local recurrence of the middle turbinate residueat 6 months after operation,the lesion and the middle turbinate were removed again,no recurrence in the follow-up of 3 years.No recurrence was found in the other patients.The clinical symptoms of all patients gradually disappeared,the shape of inferior turbinate was good,and the maxillary sinus cavity was epithelial. Conclusion Endoscopic sinus surgery with anterior lacrimal approach can fully expose the maxillary sinus cavity and completely remove the lesions in the anterior,internal,inferior and sinus cavities of the maxillary sinus.It is easy to operate with less complication and is easy to observe after operation and has satisfactory curative effect,which is worthy of promotion.