鼻内窥镜下钩突切除术的体会

随着鼻内窥镜手术的广泛开展,钩突切除术已成为内窥镜下筛窦开放与中鼻道上颌窦造口术的第一步。钩突切除后中鼻道拓宽,窦口复合体的清理均可在内窥镜下进行。钩突切除中鼻道开窗符合上颌窦粘膜纤毛的运动生理,有利于窦内分泌物的引流。我们在门诊开展功能性鼻内窥镜下钩突切除术,治疗４８例（５８侧）慢性鼻窦炎和鼻息肉患者,取得较好效果,报告如下。１　资料与方法１．１　临床资料本组４８例（５８侧）中,男２３例,女２５例,其中双侧病变１０例,均行钩突切除术。年龄１７～６５岁。全部患者均有鼻塞、多涕、额部胀痛史。经鼻内…     

经鼻内窥镜下钩突切除术

功能性内窥镜鼻窦手术(functional endoscopic sinus surgery, FESS)由3部分构成,即彻底清除不可逆病变,尽可能保留窦内黏膜,尤其要保留中鼻甲;建立良好的以筛窦为中心的各窦通畅引流,最重要的是开放上颌窦自然窦口;建立良好的鼻腔通气。手术成功的关键之一是充分扩大进入术腔的入口,即切除钩突、鼻丘气房及中鼻甲前附着端和鼻外侧壁所成夹角的部分黏膜和骨质［1］。     

慢性鼻窦炎保留钩突功能性鼻内镜手术30例临床观察

目的探讨保留钩突在鼻内镜手术中的意义,保留钩突的FESS更能维护鼻腔鼻窦的正常生理功能。方法30例单纯慢性鼻窦炎患者为实验组,实验组施行经鼻内镜下保留钩突的功能性鼻内镜手术,30例单纯慢性鼻窦炎为对照组,对照组采取经典钩突切除术。结果随访6个月,实验组治愈26例,好转2例,无效2例,有效率93.3％。对照组治愈22例,好转2例,无效6例,总有效率80.0％,两组总有效率比较P<0.05。实验组术后并发症较对照组明显减少。结论鼻窦开放术中保留或部分保留钩突维持了鼻腔的正常解剖学形态,同时避免吸人性气流对鼻窦的直接冲击,预防鼻腔粘连,使手术更加适应鼻腔鼻窦的气流特征,减少了鼻窦黏膜炎症的复发机会。     

鼻冠状位CT研究钩突解剖变异与慢性鼻窦炎的关系

目的通过鼻冠状位CT对钩突解剖变异与慢性鼻窦炎的关系进行分析研究。方法此次研究,选取我院接受CT检查的130例患者,检查时间为2017年9月至2019年11月期间,检查结果无鼻窦炎患者为对照组,慢性鼻窦炎患者为研究组,对比分析两组患者检查后钩突解剖变异与鼻窦炎的关系。结果研究组患者的钩突高度、钩突角度以及筛漏斗宽度明显高于对照组患者的各项数据(P<0.05);钩突头端附着类型与鼻窦炎关系分析中,研究组患者与对照组患者之间纸样板型、中鼻甲型发生率相对比有明显差异(P<0.05),研究组与对照组患者之间分叉型、筛顶型发生率相对比无明显差异(P>0.05);钩突其他解剖变异与鼻窦炎关系中,研究组与对照组患者之间钩突偏曲、以及肥大两项具有较为明显的差异(P<0.05),且研究组与对照组患者之间钩突气化、以及钩突缺失发生率相对比无明显差异(P>0.05)。结论数据中表明,慢性鼻窦炎患者出现钩突解剖变异几率明显较高,其中较为常见的包括纸样板型、中鼻甲型,钩突解剖变异与慢性鼻窦炎的关系较为紧密,对于慢性鼻窦炎患者治疗有着极为重要的临床意义。     

经鼻内窥镜治疗自发性脑脊液鼻漏1例

患者 ,女 ,45岁。无明显诱因左鼻流透明液体 2个月余入院。入院前 1周出现咳嗽、发热症状。检查 :头低位时可见左鼻孔有透明液体流出。鼻内窥镜下可见液体来自中鼻道。嗅觉正常。鼻冠状位CT:左前组筛窦有积液样改变 ;水平位 CT:左前组筛窦有一小高密度影 ,颅底未发现破坏。鼻溢液实验室检查 :糖 0 .576g/ L,蛋白 0 .6g/ L,氯 4.792 5g/L。胸片示左下肺感染。入院后 ,患者取半坐头前倾位 ,行抗感染治疗。体温正常、咳嗽消失后 2周行手术治疗。局麻下 ,Messer Klinger法切除前组筛窦 ,显露筛顶。见距中鼻甲前缘 1 .2 cm处内侧有一米粒大膜…     

鼻内窥镜下蝶窦及鞍区手术

目的 探讨鼻内窥镜下蝶窦及鞍区手术的临床效果。方法 内窥镜下经鼻腔入路治疗垂体腺瘤２例、蝶窦子弹异物２例、霉菌病２例和蝶窦囊肿１例。结果 蝶窦囊肿和霉菌病痊愈;蝶窦异物１例失败;垂体腺肿瘤患者视力恢复、脑脊液鼻漏治愈。结论 鼻空窥镜下蝶窦及鞍区手术,操作简单,安全有效,治疗鞍区病变有一定的价值。     

在鼻内镜手术中选择性保留钩突的疗效观察

内镜鼻窦手术是20世纪鼻科领域具有划时代意义的成就,它促进了鼻腔、鼻窦诸多疾病诊治水平的飞跃发展,使鼻窦手术治愈率提高到80%~90%〔1〕。目前临床上施行内镜鼻窦手术多采用Messerklinger术式,主要步骤为切除钩突,充分暴露术野,向后开放切除前、后组筛窦,扩大上颌窦自然开口     

鼻内窥镜下鼻中隔粘膜下切除术治疗Charlin氏综合征

鼻内窥镜下鼻中隔粘膜下切除术治疗Ｃｈａｒｌｉｎ氏综合征夏贵华随着现代鼻内窥镜的临床运用，鼻腔解剖结构、生理功能研究进一步深入，人们对鼻腔疾病的诊断和治疗有新的认识，我们采用鼻内窥镜下鼻中隔粘膜下切除术治疗Ｃｈａｒｌｉｎ氏综合征取得满意效果，报告如下：...     

鼻内窥镜下纸板击出性骨折复位术

目的 评价鼻内窥镜下纸板击出骨折复位术的临床疗效。方法 对６例伴有眼球凹陷、睑裂变小及复视等着状、眶部ＣＴ（水平＋冠状）扫描显示纸板击出性骨折的患者,在确定骨折位移程度及范围后,在局部麻醉＋鼻粘膜表面麻醉上行鼻内窥镜经筛窦纸板骨折复位术,手术采用常规Ｍｃｃｓｃｒｋｌｉｎｇｅｒ入路,小心全骨折区筛房,显露骨折区纸板,用钝性剥离子,由前向后将内移的纸板外推复位,局部磺仿纱条填塞支撑,２～３周去除填塞沙     

鼻内窥镜在喉内手术中的应用

我科自１９９７～１９９８年对５５例喉部疾病患者,采用小口径鼻导管经鼻插入气管内,高频喷射通气,静脉复合麻醉;用鼻内窥镜,结合支撑喉镜下行喉内手术。取得满意疗效,报告如下。１材料与方法１．１ 临床资料：５５例中,男２６例,女２９例;年龄１８～６５岁,平均２８．６岁;均因声嘶为主诉,病程最长为２０年,最短为１月,平均４．２年。部分患者曾经在直接喉镜下手术,因暴露困难而手术失败或因手术不彻底而复发。病理诊断：声带息肉３５例,声带小结８例,声带囊肿７例,Ｒｅｉｎｋｅ水肿４例,声带乳头状瘤１例（无恶变）。…     

颈静脉球解剖变异对经内镜行岩斜坡区病变手术的影响

目的 了解颈静脉球的解剖变异对颞骨径路在内镜下行桥小脑角区病变手术的影响。方法 在20例40侧成人尸头上模拟颞骨径路内镜手术,测量相关数据。结果 颈静脉球高度为左侧(7.39±2.11)mm,右侧(9.05±3.10)mm;宽度为左侧(6.28±1.25)mm,右侧(6.34±0.79)mm;颈静脉球顶距鼓室天盖、后半规管上、下缘、上半规管顶点、内淋巴囊上缘、面神经锥段中点、内听道下缘之间距离分别为:(16.05±3.34)mm、(8.73±3.11)mm、(3.13±1.83)mm、(14.63±3.33)mm、(5.01±2.88)mm、(3.70±3.36)mm、(5.03±3.19)mm。结论 高位颈静脉球对内镜手术有一定影响,但相对非内镜手术而言要小,高位颈静脉球的定义依不同的术式而不同。     

纤维内镜检查在吞咽障碍评估中的应用研究

目的 探讨纤维内镜检查吞咽状况(fibreoptic endoscopic evaluation of swallowing, FEES)在吞咽功能评估中的应用价值.方法 对52例临床筛选有吞咽障碍的神经系统疾病患者2日内行FEES和X线造影录像(videofluoroscopy)吞咽功能检查,结果进行对比分析.结果 FEES吞咽前咽渗漏25例次(48.1%),咽潴留39例次(75.0%),喉渗入36例次(69.2%),误吸29例次(55.8%),静息性误吸15例次(28.8%);X线造影吞咽检查以上各项分别为23例次(44.2%)、33例次(63.5%)、30例次(57.7%)、24例次(46.2%)、11例次(21.2%).以X线造影存咽检查结果为金标准,FEES对于喉渗入、误吸和静息性误吸的敏感度(分别为90.0%、87.5%、90.9%、)和阴性预测值(分别为81.3%、87.0%、97.3%)很高.将患者吞咽障碍严重程度分为无喉渗入、喉渗入、误吸、静息性误吸4个等级,Kappa一致性检验显示FEES和X线造影吞咽评估结果有高度的一致性(Kappa=0.452,加权Kappa=0.713).结论 FEES可有效评估吞咽功能障碍,有利于指导患者的饮食管理和康复治疗.     

Robot-assisted endoscope guidance versus manual endoscope guidance in functional endonasal sinus surgery (FESS)

Background: Having one hand occupied with the endoscope is the major disadvantage for the surgeon when it comes to functional endoscopic sinus surgery (FESS). Only the other hand is free to use the surgical instruments. Tiredness or frequent instrument changes can thus lead to shaky endoscopic images.

Methods: We collected the pose data (position and orientation) of the rigid 0° endoscope and all the instruments used in 16 FESS procedures with manual endoscope guidance as well as robot-assisted endoscope guidance. In combination with the DICOM CT data, we tracked the endoscope poses and workspaces using self-developed tracking markers.

Results: All surgeries were performed once with the robot and once with the surgeon holding the endoscope. Looking at the durations required, we observed a decrease in the operating time because one surgeon doing all the procedures and so a learning curve occurred what we expected. The visual inspection of the specimens showed no damages to any of the structures outside the paranasal sinuses.

Conclusion: Robot-assisted endoscope guidance in sinus surgery is possible. Further CT data, however, are desirable for the surgical analysis of a tracker-based navigation within the anatomic borders. Our marker-based tracking of the endoscope as well as the instruments makes an automated endoscope guidance feasible. On the subjective side, we see that RASS brings a relief for the surgeon.     

Incorporating the endoscope into middle ear surgery

We conducted a study to evaluate the use of a pediatric rigid otoendoscope for determining the extent of middle ear disease and for assessing ossicular integrity and mobility during tympanoplasty. Our study population was made up of 132 patients who were undergoing surgery for the treatment of chronic suppurative otitis media; of this group, 41 patients underwent otoendoscopy and 91 underwent scutum lowering for purposes of visualization. In the otoendoscopy group, the ossicles were successfully visualized and their mobility assessed in 34 patients; the remaining 7 patients subsequently underwent scutum lowering. A 30 degrees endoscope allowed for complete visualization of the middle ear in almost all of the 34 cases. The mean duration of surgery for the 34 patients in the otoendoscopy group was 62.85 minutes (+/- 15.57), which was significantly shorter than the duration of surgery (71.23 +/- 15.65 min) for the 98 patients who underwent scutum lowering (p < 0.005). A total of 50 patients required less than 60 minutes of surgical time--26 of 34 (76.5%) in the endoscopy group and 24 of 98 (24.5%) in the scutum-lowering group. Statistical analysis revealed that the possibility of completing a procedure in less than 60 minutes was 73.65% (+/- 12.56%) when endoscopy was used and 58.62% (+/- 12.60%) when scutum lowering was used--again, a statistically significant difference (p < 0.005). We conclude that incorporation of an angled otoendoscope into middle ear surgery is a worthwhile alternative to scutum lowering.     

迷路后径路内镜下桥小脑角区手术

目的:评价内镜在迷路后径路桥脑小脑三角区手术中的应用价值。方法:对2例舌咽神经痛患者行迷路后径路内镜下舌咽神经根、迷走神经根上部1~2根丝切断术,术中对该手术径路在内镜下能获得的手术视野进行观察,对该手术的适应症以及优缺点进行评价。结果:2例患者均成功施行手术并获得满意疗效,通过迷路后开窗导入内镜可以获得上至三叉神经下达迷走神经的暴露范围,内耳门因其位置相对固定且较容易分辨,可以作为内镜手术的定位标志。结论:迷路后径路桥小脑角区内镜手术径路短,较显微镜手术而言具有微创、能多角度观察病变区域、更清晰分辨血管神经关系等优点,更适合耳科医生采用;缺点是手术操作相对复杂,需丰富的解剖知识以及熟练的内镜操作技巧。     

鼻内镜下窦口鼻道复合体矫正术在治疗慢性鼻窦炎中的价值

目的评价窦口鼻道复合体矫正术在治疗慢性鼻窦炎中的疗效.方法在鼻内镜下对50例(86侧)慢性鼻窦炎患者进行窦口鼻道复合体矫正,观察疗效,同时随机选择40例(70侧)以传统方法治疗作对照.结果观察组治愈率88.37%(76/86),有效率11.63%(10/86),显著优于传统术式(P＜0.01).结论鼻内镜下窦口鼻道复合体矫正术,有利于改善引流,恢复鼻腔、鼻窦的生理功能,促进鼻窦的慢性炎症消除.     

Nasal endoscope in posterior epistaxis: a preliminary evaluation

The findings of a preliminary, prospective evaluation of the role of endoscopy in the management of adult posterior epistaxis are presented. A cohort of patients managed by the endoscopic technique was compared with a control group managed by the traditional methods of nasal packing or epistaxis balloons. The endoscope allowed visualization and direct treatment of previously undiagnosed posterior bleeding points. Patients managed by the endoscopic technique had a significantly shorter duration of in patient stay than those managed by traditional methods.