不同术式治疗鼻腔鼻窦内翻性乳头状瘤疗效的比较观察

目的比较三种不同手术方式治疗鼻腔鼻窦内翻性乳头状瘤的疗效.方法分别采用鼻侧切开术、改良面中部揭翻径路联合鼻内镜手术及鼻内进路联合鼻内镜手术治疗鼻腔鼻窦内翻性乳头状瘤62例,对其治疗效果进行比较分析.结果经术后随访半年～11年,各组患者症状均消失或减轻.鼻侧切开术36例中复发8例(22.2%),改良面中部揭翻径路联合鼻内镜手术18例中,复发2例(11.1%),鼻内进路联合鼻内镜手术8例中复发1例(12.5%).复发者再次手术后治愈.结论改良面中部揭翻径路联合鼻内镜手术是治疗鼻腔鼻窦内翻性乳头状瘤可靠且有效的方法.     

面掀翻及改良半面掀翻联合鼻内镜技术在鼻科手术中的应用

目的：探讨面中部掀翻及改良半面掀翻径路鼻内镜辅助治疗鼻科疾病的方法和疗效。方法：30例患者,采用面中部掀翻术4例,半面掀翻术3例,改良术式23例。改良术式采用以患侧为主的上颌窦根治术切口,不作鼻小柱贯通切口,先完整剥离健侧的鼻中隔皮肤、黏软骨膜和骨膜及鼻底黏骨膜,不作健侧前庭切口,保留健侧鼻腔软组织结构的完整性,再作鼻中隔软骨及患侧皮肤、黏软骨膜切口与鼻前庭弧形切口,掀翻患侧半面中部软组织并联合鼻内镜切除病变。结果：所有创口一期愈合。随访6个月～3年,4例面中部掀翻术后鼻前庭狭窄1例;3例半面掀翻术中鼻中隔穿孔1例;改良术式联合鼻内镜23例无并发鼻前庭狭窄和鼻中隔穿孔等症。结论：面中部掀翻及改良半面掀翻径路联合鼻内镜,术野暴露充分,面部不留瘢痕,手术操作方便、安全;改良术式健侧鼻腔术后不必填塞,无鼻前庭狭窄等并发症发生。     

鼻内翻性乳头状瘤手术进路选择

目的探讨不同手术进路切除鼻内翻性乳头状瘤的适应证。方法对35例(39侧)鼻内翻性乳头状瘤患者术前行鼻窦CT扫描和鼻内镜检查,根据肿瘤部位和范围分别采取鼻侧切开术9例(9侧),鼻内镜下经鼻进路20例(22侧),面正中掀翻进路2例(4侧)和经鼻内外联合进路术式4例(4侧)。术后随访23个月～11年,平均37个月。结果9侧行鼻侧切开术中1侧复发(11%),22侧鼻内镜下经鼻进路中2侧复发(9%),其它进路无复发病例。结论应根据肿瘤原发部位和范围选择相应的术式。局限于筛窦、蝶窦、上颌窦窦口周围以及额隐窝周围的肿瘤可采取鼻内镜下经鼻进路手术。     

鼻内镜鼻腔内翻性乳头状瘤切除术

目的：探讨鼻内镜下内翻性乳头状瘤切除术的方法及疗效。方法：30例鼻腔鼻窦内翻性乳头状瘤中，10例有前期手术史，均为单侧发病。手术根据肿瘤不同部位选择相应的手术方式。术后定期鼻内镜下换药。结果：25例鼻腔内翻性乳头状瘤患者行鼻内镜下肿瘤切除术，2例行鼻内镜下肿瘤切除术＋鼻侧切开术，3例行鼻内镜联合柯－陆氏径路行肿瘤切除术，随访3年，复发3例。结论：鼻内镜手术治疗鼻腔鼻窦内翻性乳头状瘤要严格掌握手术适应证，术后定期随访，是提高手术治愈率的关键。     

60例鼻腔鼻窦内翻性乳头状瘤的手术疗效分析

目的：探讨鼻腔、鼻窦内翻性乳头状瘤临床治疗结果。方法：对1995年1月至1999年12月问手术治疗的鼻腔、鼻窦内翻性乳头状瘤60例的临床资料进行总结，分析病变范围、手术方式与复发的关系。结果：60例中局部复发7例。根据NIP分期，Ⅱ期、Ⅲ期和Ⅳ期的复发率分别为6．9％(2／29)，22．2％(4／18)和1／2。内镜术后复发3例，鼻侧切开术后复发2例，复发率分别为15．0％(3／20)和25．0％(2／8)。结论：病变范围越小，手术效果越好。内镜手术适用于较局限的病变，对广泛病变鼻侧切开术是一种有效的手术方式，改良鼻侧切开术可降低其术后并发症。     

鼻腔混合瘤的临床分析

目的探讨鼻腔混合瘤的临床表现、病理特点及治疗方法,以提高对此病的诊疗水平。方法回顾性分析6例鼻腔混合瘤患者的临床资料,根据术前鼻内镜和鼻窦CT等术前评估选择手术径路;其中2例行鼻侧切开术,4例行鼻内镜下肿瘤切除术。结果鼻腔混合瘤原发于鼻中隔者5例、鼻咽顶后壁1例;术后随访3年,5例痊愈,1例复发。结论鼻腔混合瘤虽属良性肿瘤,但术后易复发,首次彻底切除是预防复发的关键,术后需定期随访。     

鼻内翻性乳头状瘤的临床分期与术式选择

目的；探讨鼻内翻性乳头状瘤的临床分期和手术方式选择，以降低复发率。方法：对41例鼻内翻性乳头状瘤，根据病变的 特征将其分期为T1、T2、T3、T4期，据此，19例行鼻内镜手术，20例行鼻侧切开手术，2例行上颌骨部分或全截除术。结果：鼻内镜手术后复发率为10.5％，鼻侧切开术后复发率为15.0％。结论：鼻内翻性乳头状瘤根据CT检查和病变的特征进行临床分期，按分期选择手术方式，可以彻底切除肿瘤，降低术后复发率。     

60例鼻腔鼻窦内翻性乳头状瘤的手术疗效分析

目的:探讨鼻腔、鼻窦内翻性乳头状瘤临床治疗结果。方法:对1995年1月至1999年12月间手术治疗的鼻腔、鼻窦内翻性乳头状瘤60例的临床资料进行总结,分析病变范围、手术方式与复发的关系。结果:60例中局部复发7例。根据NIP分期,Ⅱ期、Ⅲ期和Ⅳ期的复发率分别为6.9％(2/29),22.2％(4/18)和1/2。内镜术后复发3例,鼻侧切开术后复发2例,复发率分别为15.0％(3/20)和25.0％(2/8)。结论:病变范围越小,手术效果越好。内镜手术适用于较局限的病变,对广泛病变鼻侧切开术是一种有效的手术方式,改良鼻侧切开术可降低其术后并发症。     

鼻内镜下鼻内翻性乳头状瘤手术治疗

鼻内翻性乳头状瘤传统术式采用鼻外径路,主要包括鼻侧切开术和面中掀翻术。我科自2004年1月～2007年12月,对鼻内翻性乳头状瘤按照Krouse分期法进行临床分期,选择经鼻内镜手术方式治疗52例,并规范术后随访,现报道如下。     

孤立性额窦病变的手术治疗和疗效分析

目的：探讨孤立性额窦疾病或以额窦为主体的疾病的手术方式及预后。方法：诊治27例、29侧额窦内病变,包括阻塞性炎症、化脓性炎症、额窦囊肿、额窦霉菌病、良性肿瘤等,其中16例行鼻内径路鼻内镜手术,11例行鼻内镜下鼻内外联合径路手术。患者均随访1年以上。结果：鼻内镜手术16例中术后1年4例复发,复发率为25％,其中2例行二次手术。鼻外、鼻内联合径路11例中术后1年3例复发,复发率为27．3％,差异无显著性（P〈0．01）。结论：额窦手术尤其是鼻内镜下的额窦手术较为困难,须区别病变特性,以行适当的手术和术中处理。     

Sublabial rhinotomy with septal transfixion as an approach to the nasal fossa, paranasal sinuses and nasopharynx

A sublabial incision with septal transfixion and mid-face degloving is described as an approach to the nasal cavity, paranasal sinuses and nasopharynx. A brief history of the development of the technique is given. The results of nine cases are presented. These cases have had good tumour clearance, excellent cosmetic results and the minimum of complications. The sublabial approach is most useful in children and women, particularly those with intermediate grade tumours. The advantages of the approach compared to the lateral rhinotomy incision include: superior access to the floor of the nose, inferior turbinate and anterior nasal septum; access to both sides of the nasal septum and the absence of a facial scar. The limitations of the sublabial technique are the poor access to frontal sinus and the cribriform plate.     

鼻窦骨纤维异常增殖症36例临床分析

目的 探讨鼻窦骨纤维异常增殖症的临床特征、手术方法及预后。 方法 回顾性分析南京医科大学第一附属医院2009年10月至2016年10月收治的36例鼻窦骨纤维异常增殖症患者的临床资料。所有患者均根据术前影像学结果制定手术方案:其中经鼻内镜鼻窦手术18例,传统Caldwell-Luc径路4例,鼻侧切开术7例,鼻内镜联合Caldwell-Luc径路4例,冠状切口颅骨切开术3例,冠状切口联合Caldwell-Luc径路2例。3例患者同时行鼻内镜下视神经管减压术。所有患者中28例行病变骨质彻底切除,8例行改善功能与外观的保守切除。 结果 36例平均随访6个月至5年,2例复发,余34例恢复良好。患者术后并发脑脊液鼻漏2例,颅内血肿1例。 结论 鼻窦骨纤维异常增殖症临床表现复杂,手术切除病变骨质是主要治疗方式,应在尽可能保留功能及外观的前提下,根据术前影像学检查及患者诉求个性化制定手术径路。该病症预后良好,较少复发及出现恶变。     

Comparison of techniques for transsphenoidal pituitary surgery

BACKGROUND: The aim of this study was to compare three different techniques for transsphenoidal pituitary surgery: (1) sublabial transseptal approach with microscopic resection, (2) transnasal transseptal approach with endoscopic resection, and (3) endoscopic approach with endoscopic resection. METHODS: We performed a retrospective review of 50 pituitary surgeries performed by the same neurosurgeon. Demographic, radiographic, and clinical data were collected. RESULTS: Fifteen patients underwent sublabial approach with microscopic tumor resection, 21 patients underwent the transnasal approach with endoscopic resection, and 14 patients underwent the completely endoscopic technique. There were a total of 20 complications in the sublabial group, 13 transnasal complications, and 6 endoscopic complications. Cerebrospinal fluid leak incidence was 53% in the sublabial approaches, 47% transnasal, and 28% in the endoscopic patients. Diabetes insipidus was encountered in 33% of sublabial approaches, 5% of transnasal approaches, and 7% of endoscopic approaches. Lumbar drains were required in 40% of sublabial approaches, 38% of transnasal approaches, and 7% of endoscopic approaches. Nasal packing was used in 100% of sublabial and transnasal approaches and 0% of endoscopic approaches. Mean recurrence rate and follow-up was sublabial in 6.6% (50 months), transnasal in 9.5% (11 months), and endoscopic in 0% (7 months). Average hospital stay for sublabial approaches, transnasal approaches, and endoscopic approaches was 8.3, 6.2, and 3.4 days, respectively (p < 0.05). CONCLUSION: Transsphenoidal pituitary surgery has evolved over the past several decades, because advances in technology have been the catalyst for minimally invasive surgeries. Less invasive approaches, such as the transnasal approach with endoscopic resection of tumor and the completely endoscopic .technique have less morbidity and a shorter hospital stay than traditional sublabial approaches. Continued follow-up is needed to confirm long-term benefits and similar recurrence rates.     

Endonasal endoscopic marsupialization of paranasal sinus mucoceles

Paranasal sinus mucoceles are relatively common in Japan, especially after prior Caldwell-Luc surgery. Recently developed endonasal endoscopic approaches were used for the drainage and marsupialization of mucoceles. We present the surgical treatment of 97 patients with mucoceles, including 68 maxillary, 13 ethmoid, nine frontal, seven sphenoid, eight frontoethmoid, and one sphenoethmoid sinuses. Six patients with maxillary mucoceles were operated via a sublabial incision. For frontal mucoceles, four patients were treated by a combined external and endonasal endoscopic approach. The other mucoceles underwent complete marsupialization under endonasal endoscopic control. There were no intraoperative or postoperative complications. No evidence of recurrence was observed in any patients during follow-up periods ranging from 36 to 84 months.     

Endoscopic transnasal transsphenoidal surgery for pituitary tumors--intranasal procedures

We have been performing intranasal procedures and postoperative nasal treatments in patients undergoing microscopic transseptal pituitary surgery for the past twenty years. This surgery is safe and minimally invasive and has become the standard procedure for removing pituitary adenomas. Recent advances in optical technology have increased the use of endoscopy in endonasal sinus surgery. Several methods for endoscopic transnasal pituitary surgery have been reported. Here, we report the results for 31 patients (34 operations) who were treated with endoscopic transnasal pituitary surgery. This technique enables the area of surgery to be visualized without requiring a sublabial incision or septal ablation to be performed. Five of the cases were for recurrences after microscopic surgery. A transsphenoidal surgical approach via a unilateral nasal cavity was used in 32 cases. For the remaining two cases, a transsphenoidal surgical approach via bilateral nasal cavities was used in 1 case, and a transethmoidal-transsphenoidal surgical approach via a unilateral nasal cavity was used in 1 case. Excellent results comparable to those of microscopic transseptal surgery were obtained. Endoscopic transnasal transsphenoidal surgery was found to have the following advantages: low-invasiveness, a wide and clear surgical view, and a relatively short operating time in the nose and sinus, especially for recurrent cases. This endoscopic procedure should therefore be considered as the first choice for pituitary surgery.     

复发性鼻腔鼻窦内翻性乳头状瘤的临床分析

目的:探讨复发性鼻腔鼻窦内翻性乳头状瘤经鼻内镜手术的疗效。方法:回顾性分析7例复发性鼻 腔鼻窦内翻性乳头状瘤患者经鼻内镜切除的疗效,并与14例经鼻侧切开术进行比较分析。结果:7例经鼻内镜 手术者术后随访时间为1～3年,14例经鼻侧切开手术者术后随访时间为1～10年,均未见肿瘤再次复发。结 论:经鼻内镜手术是治疗复发性鼻腔鼻窦内翻性乳头状瘤的有效方法。     

Clinical and pathological analysis of recurrent inverted papilloma

OBJECTIVES: We analyzed the clinical characteristics, pathological findings, and treatment outcomes of patients with recurrent sinonasal inverted papilloma (IP). METHODS: This retrospective study consisted of 13 patients with recurrent IP. Patient data were collected on prior treatment, sites of recurrence, surgical procedures, pathological findings, and postoperative time to recurrence. RESULTS: Eleven of the 13 patients (85%) had recurrence in the ethmoid sinus, particularly at the lamina papyracea (n = 8; 62%). Inverted papilloma with severe dysplasia (SD) was observed in 4 patients, 3 of whom showed malignant transformation of the recurrent tumor. Craniofacial resection was performed in 2 of the 4 patients, resulting in no further recurrence. However, the tumor was not managed in the remaining 2 patients. In the 9 patients without SD, lateral rhinotomy was performed in 6 patients and endoscopic sinus surgery was selected in 3 patients who had a small tumor without scar formation. No further recurrence was observed in the 9 patients. CONCLUSIONS: Careful management of IP around the lamina papyracea is essential during initial surgery. Recurrent IP without SD can be successfully managed by lateral rhinotomy in most cases, and by endoscopic sinus surgery in selected cases. However, more aggressive treatment, including craniofacial resection, should be considered in IP with SD, which is associated with a high rate of recurrence and malignant transformation.     

外伤性额窦脑脊液鼻漏的治疗

目的 探讨经鼻内窥镜外科治疗额窦脑脊液鼻漏的适应证、操作技巧及优点。方法 经鼻内窦镜外科治疗外伤性额窦脑脊液鼻漏６例,利用经鼻内窥镜外科技术开放和扩大鼻额管,在直视下找到瘘口,应用自体碎肌肉覆盖瘘口,外加肌膜和明胶海棉、碘仿纱条填塞,对于单纯内窥镜下手术有困难者,结合眉弓小切口联合额窦切开进行修补。结果 ６例外伤性额窦脑脊液鼻漏患者,４例采用经鼻内窥镜外科一次修补成功,１例采用经鼻内窥镜外科联合额窦切开修补成功,１例经鼻内窥镜修补术后失败,再次手术联合鼻外额窦切开修补成功。结论 经鼻内窥镜外科技术修补脑脊液鼻漏具有操作简单、容易确定瘘口、修补成功率高等优点,对于部分内窥镜下难于到达的部分,联合应用额窦切天可弥补内窥镜下操作困难和不足,有助于提高修补瘘口的成功率。     

Midfacial degloving

Midfacial degloving is an extended sublabial rhinotomy. It permits good bilateral access to the deeper parts of the midfacial region, particularly the nasal and paranasal cavities, the base of the skull, and the clivus. The incision leaves no visible scars. The access is suitable for large benign tumors such as nasopharyngeal fibromas or inverted papillomas, but can also be used for malignant tumors. The access can be enlarged at any time by supplementary incisions to meet the demands of tumor surgery. We describe the operative technique for midfacial degloving and present a case to illustrate the applications of this technique.