鼻内镜下前颅底肿瘤切除术

目的探讨鼻内镜下前颅底区域肿瘤切除术的可行性及疗效。方法回顾性总结鼻内镜下鼻腔、筛窦及前颅底肿瘤切除术病例19例,其中筛窦鳞状细胞癌3例,嗅神经母细胞瘤3例,肾透明细胞转移癌1例,恶性黑色素瘤3例,浆细胞瘤1例,筛窦腺癌2例,腺样囊性癌4例,脑膜瘤2例。结果根据内镜下所见及术后影像学检查证实18例瘤全部切除,1例大部切除。3例恶性黑色素瘤患者中,1例术后1年死于脑转移,1例术后8个月后出现局部复发。1例腺样囊性癌患者术后17个月后复发,其余16例肿瘤患者随访12个月～3年未发现复发。结论对于局限于鼻腔、筛窦的恶性肿瘤,以及瘤体大部在鼻及鼻窦内的前颅底良性肿瘤,鼻内镜手术可以将其完整切除,对于恶性肿瘤应慎重选择病例,术后应辅以放疗。     

鼻内镜或鼻内镜辅助下鼻腔鼻窦恶性肿瘤切除术的初步分析

目的：探讨鼻内镜或鼻内镜辅助下切除鼻腔鼻窦恶性肿瘤的可行性和疗效。方法：回顾性分析我院收治的40例鼻腔鼻窦恶性肿瘤患者的临床资料。病理类型为内翻性乳头状瘤恶变5例,上颌窦癌2例,筛窦癌3例,恶性黑色素瘤11例,嗅神经母细胞瘤7例,神经内分泌癌2例,肌上皮癌4例,鼻腔软骨肉瘤2例,腺样囊性癌3例,恶性血管外皮细胞瘤1例。所有患者均行鼻内镜或鼻内镜辅助下肿瘤切除术,其中32例术后采用放化疗。结果：所有患者随访1～5年,其中22例随访1～3年,随访3年以上者18例。4例患者术后6个月～2年症状复发,再次行鼻内镜手术后疗效满意;3例术后出现颈淋巴结转移,其中2例行颈淋巴结清扫术,1例因无手术指征而行放、化疗;4例出现远处转移;8例死亡;其余21例在随访期间未见复发及转移。结论：鼻内镜或鼻内镜辅助下手术切除鼻腔鼻窦恶性肿瘤切实可行,但必须严格选择适应证,辅以术后综合治疗,可取得满意的疗效。     

内镜下或内镜辅助下的鼻腔-鼻窦恶性肿瘤手术

目的　探讨内镜下或内镜辅助下切除鼻腔 鼻窦恶性肿瘤的可行性和手术效果。方法总结 1997年起 ,在内镜下或内镜辅助下施行鼻腔 鼻窦恶性肿瘤手术的 11例患者的临床资料 ,并对部分术后患者进行随访 ,其中 5例手术后随访时间在 3年以上。 5例患者中行鼻中隔鳞状细胞癌 (简称鳞癌 )切除术 1例 ,行筛窦鳞癌切除术 1例 ,行上颌窦腺样囊性癌切除术 1例 ,行嗅神经母细胞瘤切除术 2例。结果　术后随访时间超过 3年的 5例均无局部复发 ,仅 1例嗅神经母细胞瘤术后 2年 8个月出现左侧颈淋巴结转移 ,术后 3年 10个月出现广泛的脑膜侵犯。结论　内镜下或内镜辅助下可以彻底切除经过选择的鼻腔 鼻窦恶性肿瘤 ,优点是创伤小 ,避免了颜面部瘢痕 ,提高了患者的生存质量 ,但还有待于进一步开展大样本、随机分组、长期随访的临床研究     

内镜下或内镜辅助下的鼻腔-鼻窦恶性肿瘤手术

目的 探讨内镜下或内镜辅助下切除鼻腔一鼻窦恶性肿瘤的可行性和手术效果。方法 总结1997年起，在内镜下或内镜辅助下施行鼻腔一鼻窦恶性肿瘤手术的11例患者的临床资料，并对部分术后患者进行随访，其中5例手术后随访时间在3年以上。5例患者中行鼻中隔鳞状细胞癌(简称鳞癌)切除术1例，行筛窦鳞癌切除术1例，行上颌窦腺样囊性癌切除术1例，行嗅神经母细胞瘤切除术2例。结果 术后随访时间超过3年的5例均无局部复发，仅1例嗅神经母细胞瘤术后2年8个月出现左侧颈淋巴结转移，术后3年10个月出现广泛的脑膜侵犯。结论 内镜下或内镜辅助下可以彻底切除经过选择的鼻腔-鼻窦恶性肿瘤，优点是创伤小，避免了颜面部瘢痕，提高了患者的生存质量，但还有待于进一步开展大样本、随机分组、长期随访的临床研究。     

应用鼻内镜或鼻内镜辅助下鼻腔鼻窦低度恶性肿瘤手术探讨

目的 探讨应用鼻内镜或鼻内镜辅助下切除鼻腔鼻窦低度恶性肿瘤的治疗效果.方法 回顾分析28例鼻腔鼻窦低度恶性肿瘤临床资料,其中内翻性乳头状瘤恶变 16例,低度恶性骨肉瘤 1例,腺样囊性癌5例,低度间叶组织肿瘤2例,血管外皮瘤 3例,鼻腔混合瘤恶变1例.均在鼻内镜下或鼻内镜辅助下切除肿瘤.术后19例加放射治疗.结果 术后随访4年以上的24例无局部复发;1例低度间叶组织肿瘤,3例内翻性乳头状瘤恶变,1～2年后出现鼻腔复发,再次行同类手术,术后1例内翻性乳头状瘤恶变出现广泛脑膜侵犯死亡.结论 只要掌握好适应证,内镜或内镜辅助下可以切除部分鼻腔鼻窦恶性肿瘤,且创伤小,避免了颜面部瘢痕,提高了患者的生存质量.     

内镜或内镜辅助下切除鼻腔鼻窦恶性肿瘤

鼻内镜技术应用于临床已逾30年,目前对于经鼻内镜下治疗鼻和鼻窦的良性肿瘤,基本已形成正面的意见。然而对于完全鼻内镜下切除鼻和鼻窦恶性肿瘤则还存在争议[1],国外近年有较多的治疗和观察报道[2～6],现就我科采用内镜下切除鼻腔恶性肿瘤报道如下。1资料与方法1.1临床资料。收集我科2005年4月～2008年1月鼻窦恶性肿瘤7例,其中男3例,女4例,年龄14～50岁。鳞状细胞癌3例、乳头状瘤恶变、腺癌、腺样囊性癌、嗅母细胞瘤各1例。     

小儿先天性鼻腔鼻窦肿物的临床诊疗观察

目的 探讨小儿先天性鼻腔鼻窦肿物的诊断及鼻内镜手术治疗的安全性和有效性.方法 回顾性分析上海交通大学医学院附属新华医院收治的24例先天性鼻腔鼻窦肿物患儿的临床资料.术前进行鼻内镜、鼻窦CT和MRI检查,全部病例经鼻内镜下鼻腔鼻窦肿物切除术,术后随访手术疗效.结果 24例中良性占位17例,其中脑膜脑膨出8例、骨化纤维瘤3...     

鼻内镜下颅底恶性肿瘤切除的初步探讨

目的探讨鼻内镜下切除侵犯颅底或原发于颅底的鼻腔鼻窦恶性肿瘤的可行性。方法回顾性分析1998年1月～2007年5月我院收治的40例鼻腔鼻窦恶性肿瘤侵犯颅底或原发于颅底恶性肿瘤患者,鼻内镜或鼻内镜辅助下手术切除病灶。结果4例患者术后6个月至2年内症状复发,再次鼻内镜手术效果满意。所有病例随访1年以上,死亡3例,失访7例,其中随访3年以上9例。结论鼻内镜下手术切除鼻腔鼻窦侵犯颅底或颅底原发性恶性肿瘤切实可行,但必须严格选择适应证。     

改良面部正中翻揭术在鼻腔鼻窦肿瘤手术中的应用探讨

目的 :探讨有效的治疗鼻腔、鼻窦肿瘤手术方法。方法 :利用改良面部正中翻揭术治疗 2 4例鼻腔、鼻窦肿瘤的病人 ,其中 6例结合内镜技术。该术式将传统正中翻揭术的鼻前庭环形切口改为鼻中隔的贯穿切开和鼻腔外侧壁的骨膜下切开。本组病例 ,筛窦骨瘤 2例 ,鼻中隔血管瘤 1例 ,鼻腔、筛窦血管瘤 3例 ,鼻腔、上颌窦血管瘤 3例 ,鼻腔筛窦内翻乳头状瘤 7例 ,鼻腔筛窦鳞癌 2例 ,鼻腔鳞癌 3例 ,上颌窦鳞癌 2例 ,复发性上颌窦鳞癌 1例。鼻腔筛窦内翻乳头状瘤和恶性肿瘤 ,皆未侵犯前筛窦、前颅底及眼眶。鼻腔筛窦内翻乳头状瘤和鳞癌术后皆行放疗。结果 :2 4例手术皆成功。该手术切口可变通 ,对鼻腔、鼻窦、鼻咽及前中颅底皆可充分暴露 ,结合内镜技术可减少术中创伤和术后并发症。患者对术后外形皆满意。无鼻前庭狭窄、鼻中隔穿孔、口鼻瘘管等 ;12例面部麻木术后 6个月均渐好转 ;5例溢泪皆行泪道冲洗后好转 ;1例复发性上颌窦癌病人再次手术后 3个月因肺部转移死亡 ;1例鼻腔筛窦内翻乳头状瘤术后 8个月复发。结论 :改良面部正中翻揭术是一种变通而实用处理鼻腔、鼻窦肿瘤的方法     

鼻内镜下T3期鼻内翻性乳头状瘤切除术

目的探讨鼻内镜下治疗T3期鼻腔鼻窦内翻性乳头状瘤的疗效。方法总结12例T3期鼻腔鼻窦内翻性乳头状瘤经鼻内镜手术切除的治疗效果。结果 12例随访7～36个月,仅2例术后复发(16.6%),其中1例累及上颌窦、筛窦与蝶窦,1例累及上颌窦、额窦、筛窦及蝶窦。结论鼻内镜下行T3期鼻腔及鼻窦内翻性乳头状瘤切除术有良好疗效。     

带蒂鼻中隔黏膜瓣在侵及前颅底鼻腔鼻窦恶性肿瘤切除术颅底重建中的应用

目的　回顾性分析应用带蒂鼻中隔黏膜瓣修复内镜下切除侵及颅底鼻腔鼻窦恶性肿瘤术后颅底缺损的效果。方法　2008年9月～2016年5月内镜下切除侵及颅底鼻腔鼻窦恶性肿瘤31例,应用以鼻后中隔动脉和筛前-筛后动脉为供血的两种类型带蒂鼻中隔黏膜瓣,修复重建前颅底切除后较大颅底缺损。结果　31例患者前颅底重建均一次性修补成功。1例肿瘤复发二次手术患者术后发生脑脊液漏,给予椎管置管引流1周愈合;1例术后10 d撤出鼻腔填塞物后出现脑脊液鼻漏,颅内感染3例,余无颅内出血或血肿等并发症发生。术后随访3～66个月见黏膜瓣愈合良好,无移植瓣膜坏死和脑膜脑膨出发生。结论　血管化带蒂鼻中隔黏膜瓣是内镜颅底外科的一种首选的、可靠的前颅底修补用材料。     

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。     

Endoscopic techniques in resection of anterior skull base/paranasal sinus malignancies

OBJECTIVE: The objective of this study was to examine the role of endoscopic approaches to the resection of anterior skull base and paranasal sinus malignancies at one tertiary care medical center. STUDY DESIGN: The authors conducted a retrospective chart review over a period of 17 years. METHODS: Patients undergoing anterior skull base resections for malignancies over a 17-year period were reviewed. Data were collected on each patient with respect to the pathology of the tumor and approach used as well as demographic and follow-up information. RESULTS: A total of 78 patients were treated at a tertiary care medical center for malignancies of the paranasal sinuses and anterior skull base. The most common diagnosis was squamous cell carcinoma occurring in 33% of the cases. The remaining pathologies included esthesioneuroblastoma (23%), adenoid cystic carcinoma (15%), melanoma (3%), sinonasal undifferentiated carcinoma (3%), lymphoma (5%), nasopharyngeal carcinoma (4%), and other tumor types (14%). Endoscopic techniques were used extensively in this population of patients. Combined approaches using a sublabial/transmaxillary approach and coronal approaches were used when indicated and complemented the endoscopic approach. A majority of patients were without evidence of disease at the end of this review. Using endoscopic techniques allowed for acceptable cosmetic results and facial incisions were used minimally. CONCLUSION: With complete endoscopic surgical resection followed by radiation therapy, local recurrence, morbidity, and cosmetic deformity have been minimized. The microscopic view provided by endoscopic techniques, with or without complementary approaches, allows for complete tumor removal.     

Endoscopic surgery for malignant tumors of the sinonasal tract and adjacent skull base: a 10-year experience

BACKGROUND: The increasing expertise in the field of transnasal endoscopic surgery recently has expanded its indications to include the management of sinonasal malignancies. We report our experience with the endoscopic management of nasoethmoidal malignancies possibly involving the adjacent skull base. METHODS: A retrospective analysis was performed of patients treated by an exclusive endoscopic approach (EEA) or a cranioendoscopic approach (CEA) from 1996 to 2006 managed by two surgical teams at the Departments of Otorhinolaryngology of the University of Brescia, and the University of Pavia/Insubria-Varese, Italy. RESULTS: One-hundred eighty-four patients were considered eligible for the present analysis. An EEA was performed in 134 patients and the remaining 50 patients underwent the CEA. The most frequent histotypes encountered were adenocarcinoma (37%), squamous cell carcinoma (13.6%), olfactory neuroblastoma (12%), mucosal melanoma (9.2%), and adenoid cystic carcinoma (7.1%). Overall, 86 (46.7%) patients received some form of adjuvant treatment. The patients were followed up for a mean of 34.1 months (range, 2-123 months). The 5-year disease-specific survival was 91.4 +/- 3.9% and 58.8 +/- 8.6% (p = 0.0004) for the EEA and CEA group, respectively. CONCLUSION: To the best of our knowledge, this is the largest series reported to date of malignant tumors of the sinonasal tract and adjacent skull base treated with pure endoscopic or cranioendoscopic techniques. A 5-year disease-specific survival of 91.4% and 58.8% for the EEA and the CEA groups, respectively, seem to indicate that endoscopic surgery, when properly planned and in expert hands, may be a valid alternative to standard surgical approaches for the management of malignancies of the sinonasal tract.     

Endoscopic or endoscope-assisted surgery for sinonasal malignancy]

OBJECTIVE: To discuss the feasibility and therapeutic efficacy of resection of sinonasal malignant tumours through endoscopic or endoscope-assisted surgery. METHODS: Since 1997, 11 cases of malignant tumours were resected under endoscope or by endoscope-assisted surgery. Among them, 5 patients were followed-up for more than 3 years, including one case of nasal septum squamous cell carcinoma; one case of ethmoid sinus squamous cell carcinoma; one case of maxillary sinus adenoid cystic carcinoma and two cases of olfactory neuroblastoma. RESULTS: In the patients who were followed-up for more than three years, no local recurrence was found. There was only one case of cervical lymph node metastasis found on a patient with olfactory neuroblastoma 2. 5 years after resection. Four years after operation, this patient was suspected to have extensive metastasis in meninges, and only palliative treatment was suggested. CONCLUSIONS: By endoscope or by endoscope-assisted surgery, some of selected sinonasal malignant tumours can be thoroughly resected. The advantages are mini-invasive and avoidance of facial scar so as to improve the quality of life (QOL) of patients. Large amount of cases, random clinical study with lone- term follow-up are still needed to verify the feasibility and efficacy of endoscopic or endoscope-assisted surgery.     

3D打印技术在鼻鼻窦恶性肿瘤外科中的应用

 目的探讨3D打印技术在鼻鼻窦恶性肿瘤切除及术后重建中的应用。方法回顾分析2015年1月~2017年6月我科收治的鼻鼻窦恶性肿瘤并进行手术治疗的10例患者临床病理资料。其中鳞癌4例,骨肉瘤1例,嗅神经母细胞瘤2例,腺样囊性癌2例,黏液表皮样癌1例。所有患者术前均行鼻鼻窦CT扫描,3D重建并打印出病变鼻窦模型,在模型上进行术前设计及模拟手术,确定肿瘤切除范围、需修复重建部位,确定手术方案后进行肿瘤切除及同期重建。术后均予以放疗并密切随访,通过CT复查与功能检查,对疗效、手术精准度及功能恢复进行评价。结果经3D打印术前设计,全部患者顺利完成肿瘤切除术,8例患者同期行缺损部位修复重建,其中6例患者上颌骨和眶壁骨质缺损植入钛网,2 例患者颅底骨质缺损较大行鼻中隔黏骨膜瓣修复,2例缺损较小且硬脑膜完整者未行骨性重建。术中能够明确肿瘤与解剖结构的位置关系并实现了全部切除、准确定位缺损并修复,精确度高。术后CT复查显示切除范围、骨缺损部位、重建外形与术前设计基本一致。10例患者术后愈合良好,无严重并发症。患者随访12~30个月,肿瘤无复发。结论3D打印技术在鼻鼻窦恶性肿瘤的外科治疗中可以实现术前设计、手术模拟及术后预测,具有较好的可行性和可靠性,有助于鼻鼻窦恶性肿瘤切除范围的确定、缺损重建,可提高鼻鼻窦恶性肿瘤手术治疗的精确性、临床治疗效果及患者术后生活质量。     

Endoscopic endonasal technique: treatment of paranasal and anterior skull base malignancies

Technical and technological innovations have spearheaded the expansion of the indications for the use of endoscopic endonasal approaches to extirpate malignancies of the sinonasal tract and adjacent skull base.ObjectiveCritical review of the available literature regarding the use of endoscopic endonasal approaches including indications, limitations, surgical techniques, oncologic outcome, and quality of life.MethodVarious endoscopic endonasal techniques are reviewed according to the origin and local extension of sinonasal and skull base malignancies including anterior cranial base, nasopharynx, clivus, and infratemporal fossa. In addition, the available literature is reviewed to assess outcomes.ConclusionEndoscopic endonasal approaches are an integral part of the armamentarium for the treatment of the sinonasal tract malignancies and skull base. In properly selected cases, it affords similar oncologic outcomes with lower morbidity than traditional open approaches. Nonetheless, these minimal access approaches should be considered a complement to well-established open approaches, which are still necessary in most advanced tumors.     

Sinonasal papillomas: A report of 82 cases in copenhagen county,including a longitudinal epidemiological and clinical study

The present epidemiological and clinical study comprises 82 patients with sinonasal papillomas diagnosed from 1975 to 1993. Histology showed 58 cases of inverted papillomas including 5 cases of associated carcinoma, 19 cases of exophytic papilloma, and 5 cases of columnar cell papilloma. The incidence of sinonasal papillomas in Copenhagen County was 0.74 per 100,000 inhabitants per year. The inverted and columnar cell papillomas were typically located in the middle meatus with a varying degree of involvement of the adjacent sinuses. The exophytic papillomas were predominantly located multicentrically on the nasal septum. Good results of treatment, especially with regard to inverted papillomas, were not correlated to the aggressiveness of surgery. A lateral rhinotomy with medial maxillectomy was performed as primary surgery in 28 patients. In 50% of these patients there were recurrences. The preliminary results of endonasal endoscopic surgery revealed a high success rate, i.e., no recurrences in 5 cases so far. The septal papillomas were typically resected by a simple endonasal procedure. There were recurrences in 66% of these cases. The midfacial degloving procedure may be advocated instead of or as a supplement to the lateral rhinotomy if the tumor cannot be visualized sufficiently by endoscopy. Smoking may dispose to sinonasal papillomas.