原发于蝶窦外侧隐窝囊肿的诊断与鼻内镜手术治疗

目的　探讨原发于蝶窦外侧隐窝囊肿的临床特征及鼻内镜治疗的疗效。方法　回顾性分析我院2007～2015年间收治的9例原发于蝶窦外侧隐窝囊肿患者的临床资料及术后随访结果。其中7例患者以面颊部麻木感为主诉,2例患者进行性视力下降为主诉;头面部均无明显阳性体征。均于全麻内镜下经蝶窦入路行囊肿开窗引流术。结果　所有患者术中及术后均无并发症发生,术后症状均消失。随访6～24个月,所有患者的囊肿引流口均与蝶窦相通形成永久性引流口,无闭塞或复发。结论　①原发于蝶窦外侧隐窝囊肿的有其独有的症状及影像学特征,区别于一般的蝶窦囊肿;②鼻内镜下经蝶窦入路行囊肿开窗切除术是治疗原发于蝶窦外侧隐窝囊肿的微创、安全、有效术式。     

Radical sphenoidectomy with nasopharyngeal flap

Chronic sphenoid sinusitis is a common problem with serious consequences. Ocular disturbance, blindness and even death can occur as a consequence of this chronic infection. Sphenoid marsupialization is a procedure in which the floor of the sinus, which is a common wall with the roof of the nasopharynx, is removed endoscopically and a flap of nasopharyngeal vault mucosa is placed within the sinus. This diminishes the sinus size and opens it completely so that it will not be a site of collection of purulent material in the future. Five patients are illustrated who had severe refractory chronic sphenoid sinusitis, all of which have had previous surgery and all treated successfully with sphenoid marsupialization.     

Infectious diseases of the sphenoid sinus

Thirty-one patients with sphenoid sinusitis were treated from 1978-1982. Twenty patients had infections contiguous with other paranasal sinus disease. Five of these patients had fungal sinusitis. Eleven patients were seen with isolated sphenoid sinusitis; 3 were secondary to trauma and 8 were due to nontraumatic causes. Possible etiologies include upper respiratory infections, developmental abnormalities, and water forced into the nasal cavity during swimming. The immunocompromised patient is more likely to present with minimal symptoms with a fungal infection, and aggressive diagnostic and therapeutic measures should be undertaken. Because the symptoms of headache, nasal stuffiness, proptosis, ptosis and decreased visual acuity may be interpreted as an intracranial, neurological, or vascular problem, a misdiagnosis may be made. A high index of suspicion for sphenoiditis should be maintained. Therapy involves a combination of medical (antimicrobial agent) and surgical (sinus drainage and marsupialization) management.     

孤立性蝶窦疾病的诊断和治疗

目的探讨孤立性蝶窦疾病的临床表现,提高首诊准确率,并寻求合适的治疗方法。方法22例术前均行CT或MRI和鼻内镜检查,术中取病变组织送病理明确诊断。结果经鼻内镜手术后随访5个月至两年半,22例症状明显好转,蝶窦前壁通畅,窦壁光滑。结论孤立性蝶窦疾病并非罕见,头痛是常见非特异性症状,可伴有视力下降等颅神经损害及血性涕等症状。鼻内镜手术是治疗本病的首选术式。     

真菌球型蝶窦炎临床分析

目的 提高对孤立性真菌球型蝶窦炎的认识,有利于早期诊断和治疗.方法 回顾性分析10例孤立性真菌球型蝶窦炎的临床表现、影像学特点、鼻内镜手术方法及疗效.结果 10例患者最主要的临床表现为头痛或/和涕中带血,主要影像学特征为单侧蝶窦内软组织影,骨壁增厚,中央常可见高密度钙化斑.全部患者鼻内镜下行蝶窦开放术,定期换药,随访3～18个月,全部治愈.结论 孤立性真菌球型蝶窦炎临床表现无特异性,早期不易发现,CT扫描及鼻内镜检查有利于早期诊断,病理学检查可确诊,采用鼻内镜下蝶窦开放术具有创伤小、并发症少和术后恢复快等优点,值得推广.     

Isolated sphenoid sinus diseases: report of 76 cases

CONCLUSION: Inflammatory diseases, such as non-specific sinusitis, fungal sinusitis and mucocele, commonly involve the sphenoid sinus. Endoscopic surgery provides an easy and successful access to isolated sphenoid sinus diseases (ISSDs) with rare complications. OBJECTIVES: The incidence of ISSDs has decreased since a wide use of antibiotics. ISSDs can cause severe complications due to the deep location in the skull base. Endoscopic surgery for the sphenoid sinus has recently become popular, with several advantages. The aim of this study was to analyse ISSDs in terms of the clinical symptoms, histological diagnosis and treatment outcomes with our 22 years' experience. PATIENTS AND METHODS: Seventy-six patients with ISSDs, who were treated at Seoul National University Hospital between 1985 and 2007, were analysed. Patients with lesions confined to the sphenoid sinus were included. A retrospective chart review was performed with respect to the symptoms, pathology and treatment outcomes. RESULTS: Fifty-seven of 76 cases were inflammatory lesions, 9 neoplastic lesions and 10 fibrous dysplasia. Headache was the most common symptom (65.8%), followed by nasal obstruction (22.4%) and postnasal drip (21.0%). Ophthalmologic symptoms were observed in 15 cases (19.7%). Endoscopic sphenoidotomy was performed in 51 of the 57 ISSDs. Symptoms completely improved in 92.2% of the patients.     

孤立性蝶窦疾病18例临床分析

目的：探讨孤立性蝶窦疾病的诊断及合理的治疗方法。方法：回顾性分析18例经鼻内镜手术治疗的孤立性蝶窦疾病患者的临床资料。结果：18例中，炎性疾病l5例(急性炎症2例，慢性炎症3例，囊肿8例，真菌病2例)，恶性肿瘤3例。经鼻内镜手术后随访3个月至半年，蝶窦前壁开窗通畅，窦腔各壁光滑，症状明显改善，无并发症发生。结论：头痛是孤立性蝶窦疾病的常见症状，另有视力损害、血性涕及其他脑神经麻痹症状，CT、MRI及鼻内镜检查为其诊断提供有力依据；鼻内镜手术治疗是一种安全、有效、简便的方法。     

Treatment of isolated sphenoid sinus inflammatory disease by endoscopic sphenoidotomy without ethmoidectomy

OBJECTIVES/HYPOTHESIS: Isolated chronic sphenoid sinusitis is a rare entity. The study was conducted to determine the efficacy of endoscopic sinus surgery with partial middle turbinectomy and without ethmoidectomy in treating isolated sphenoid opacification from inflammatory and infectious disease. STUDY DESIGN: Case series of 20 patients generated by retrospective review of 307 consecutive patients who underwent surgical treatment for chronic rhinosinusitis. METHODS: The medical records were reviewed for pertinent demographic, symptom, radiographic, and endoscopic data preoperatively, interoperatively, and postoperatively. All patients in the series underwent computed tomographic image-guided endoscopic sphenoid sinus surgery with partial middle turbinectomy. RESULTS: The study population consisted of 12 male and 8 female patients between 28 and 75 years of age. Headache (15 patients) and/or postnasal drip (14 patients) were the presenting symptoms in 17 of the patients. Three patients were asymptomatic. Surgical findings included inspissated secretions (15 patients), fungal debris (2 patients), and mucopyoceles (3 patients). The 17 patients with preoperative symptoms were symptom free by 12 weeks postoperatively and have remained so with follow-up ranging from 12 months to 3.25 years (mean follow-up, 23.1 mo). There were no operative complications in the series. CONCLUSIONS: Endoscopic sphenoid sinus surgery without ethmoidectomy is effective for treating isolated sphenoid sinus opacification associated with inflammatory or infectious sinus disease. Partial middle turbinectomy at the time of surgery facilitates the approach, as well as postoperative cleaning and surveillance.     

蝶窦和筛窦真菌球性病变急性发作的诊断及治疗

目的:分析蝶窦和筛窦真菌球性病变急性发作时的特征,提高诊断的准确性和治疗的及时性。方法:回顾分析18例真菌球性蝶窦炎和筛窦炎患者资料,急性发作时症状以头痛、发热为主,鼻内镜检查、鼻窦CT与MRI可以协助诊断。13例患者药物抗炎治疗后行鼻内镜下鼻窦开放手术;5例患者拒绝手术,随访观察。结果:13例患者病理证实为真菌病变,完全去除病变后患者恢复良好。术前CT与MRI显示结果与术中所见一致。1例未手术者2.5个月后发生头痛,应用抗生素及鼻腔药物后症状改善。结论:临床特征和影像学检查有助于蝶窦和筛窦真菌球性病变急性发作的鉴别诊断,并采取针对性治疗。     

鼻内镜下慢性蝶窦炎手术

目的：探讨经鼻内镜手术治疗慢性蝶窦炎的方法和疗效。方法：50例84侧慢性蝶窦炎患者，均采用鼻内镜手术治疗。结果：经6～12个月随访复查，根据内镜鼻窦手术疗效评定标准，治愈61侧，占72．62％；好转13侧，占15．48％；无效10侧，占11．90％；有效率为88．10％。结论：经鼻内镜手术治疗慢性蝶窦炎具有视野清楚，手术进路安全，创伤小，患者痛苦小，疗效好等优点。     

慢性蝶窦炎

蝶窦炎因其特殊的解剖部位及无独特临床症状，往往被临床医师忽视，以往报道少。本组分析了５８例蝶窦炎，其特异的临床症状不明显，由于ＣＴ、ＭＲＩ和鼻内窥镜的广泛应用，使本病诊断已不困难。鼻内窥镜下的手术处理，患者痛苦少，操作简单。本组大部分病例（５３例）为继发于鼻腔及筛窦病变的蝶筛窦炎，孤立性蝶窦炎５例，在临床上比较少见。     

鼻内镜联合显微镜行蝶窦及经蝶鞍区微创手术

目的探讨经单侧鼻腔直接入路行蝶窦及经蝶鞍区微创手术的方法。方法鼻内镜下用Hardy′s撑开器外移中鼻甲,扩大鼻腔,直达并开放蝶窦前壁,联合显微镜切除病变。结果12例孤立性蝶窦炎术后窦口开放良好,症状消失。9例蝶窦囊肿、脑膜瘤一次手术切除。1例蝶窦骨瘤术后症状消失。1例外伤性失明视神经管减压,术后视力无恢复。33例垂体瘤中 18例行全切除术,12例行次全切除术,3例行大部分切除术,术后补充X刀治疗。56例术后随访6个月～3.5年,蝶窦炎、蝶窦囊肿、脑膜瘤、蝶窦骨瘤术后无复发,3例垂体腺瘤复发,无颅内及鼻腔并发症。结论鼻内镜联合显微镜经单侧鼻腔直接入路行蝶窦及经蝶鞍区手术,创伤小、时间短、出血少、并发症少、效果好,是目前较好的蝶窦及经蝶鞍区微创术式。     

真菌性鼻窦炎CT的非特征性表现

目的：回顾分析真菌性鼻窦炎患者术前CT,提出非特征性的临床表现,以提高术前诊断的准确性。方法：术后病理诊断为真菌性鼻窦炎患者CT176例,术前均行鼻窦CT检查及鼻内镜检查。所有患者均经鼻内镜下鼻窦开放术,术中清理窦内病变并经病理检查证实为真菌感染。其中单纯蝶窦35例,单纯上颌窦84例,筛窦上颌窦49例,全组鼻窦3例,筛窦蝶窦5例。观察以上各组术前CT除病变钙化特征以外的非特征性表现。结果：本组患者共176例179侧,其中单侧173例,双侧3例（全组鼻窦感染）。CT的非特征性改变包括：窦内病变密度均匀增高,窦内病变密度不均匀增高,受累鼻窦内侧壁可有骨质吸收。病理证实179侧中,单纯蝶窦组CT病变钙化27侧,CT病变非特征性改变8侧,其中窦内均匀密度增高5侧,不均匀密度增高3侧;单纯上颌窦组病变钙化72侧,病变非特征性改变12侧,其中窦内均匀密度增高8侧,不均匀密度增高4侧,伴有骨质吸收5侧;筛窦上颌窦组病变钙化36侧,病变非特征性改变13侧,其中窦内均匀密度增高9侧,不均匀密度增高4侧,伴有骨质吸收6侧;全组鼻窦组病变钙化6侧;筛窦蝶窦组病变钙化5例。窦内病变钙化达81.56％。结论：窦内病变的钙化被视为真菌性鼻窦炎CT的特征性表现,但在临床工作中可观察到部分真菌性鼻窦炎术前CT的非特征性改变。当缺乏CT的特征性表现时,仅通过CT尚不能作出真菌性鼻窦炎的术前诊断,需其他检查手段来做鉴别诊断,甚至需经手术探查后的病理诊断来确诊。     

孤立性蝶窦疾病的诊断及其鼻内镜手术治疗

目的：探讨孤立性蝶窦疾病的临床特点、影像学特征和鼻内镜手术的疗效。方法：38例孤立性蝶窦疾病患者,35例行鼻窦CT（其中5例同时行MRI）,3例行单纯鼻窦MRI,1例行脑池CT造影。所有患者均行鼻内镜下蝶窦开放术,其中有33例采用经鼻腔嗅裂径路,5例采用经前筛一后筛径路（即Messerklinger技术）。结果：术后随访6个月以上,34例病情完全控制,4例部分控制。术中和术后均未出现严重并发症。结论：孤立性蝶窦疾病临床症状不典型,无特异性,鼻部检查多无阳性体征,仅有以头痛为主诉的神经系统症状,早期常难以确诊。鼻窦CT和MRI是诊断孤立性蝶窦炎的最佳手段,而鼻内镜手术则是治疗该病的首选方法。     

Isolated sphenoid sinus diseases: report of 76 cases

Conclusion. Inflammatory diseases, such as non-specific sinusitis, fungal sinusitis and mucocele, commonly involve the sphenoid sinus. Endoscopic surgery provides an easy and successful access to isolated sphenoid sinus diseases (ISSDs) with rare complications. Objectives. The incidence of ISSDs has decreased since a wide use of antibiotics. ISSDs can cause severe complications due to the deep location in the skull base. Endoscopic surgery for the sphenoid sinus has recently become popular, with several advantages. The aim of this study was to analyse ISSDs in terms of the clinical symptoms, histological diagnosis and treatment outcomes with our 22 years’ experience. Patients and methods. Seventy-six patients with ISSDs, who were treated at Seoul National University Hospital between 1985 and 2007, were analysed. Patients with lesions confined to the sphenoid sinus were included. A retrospective chart review was performed with respect to the symptoms, pathology and treatment outcomes. Results. Fifty-seven of 76 cases were inflammatory lesions, 9 neoplastic lesions and 10 fibrous dysplasia. Headache was the most common symptom (65.8%), followed by nasal obstruction (22.4%) and postnasal drip (21.0%). Ophthalmologic symptoms were observed in 15 cases (19.7%). Endoscopic sphenoidotomy was performed in 51 of the 57 ISSDs. Symptoms completely improved in 92.2% of the patients.     

鼻内窥镜手术治疗蝶,筛窦囊肿17全地

目的：对鼻内窥镜手术治疗蝶、筛窦囊肿疗效进行评估。方法：回顾总结１７例鼻内窥镜手术治疗蝶、筛窦囊肿及３￣９年阴访的资料。结果：１７例央内窥镜下均良好暴露术野,术后囊腔得到充分引流;１５例获得满意疗效,无严重并发症发生。结论：鼻内窥镜下囊肿开放引流术是一种治疗蝶、筛窦囊肿安全、有效的方法。     

Isolated inflammatory sphenoid sinus disease in children

Isolated inflammatory disease of the sphenoid sinus is very uncommon in the pediatric population. A 10-year review of all patients at our institution 16 years of age or younger with inflammatory sphenoid sinus disease found 8 patients with isolated sphenoid sinusitis and 3 with sphenoid mucoceles. The most common symptoms were headache and visual disturbance. Five patients with uncomplicated sinusitis were successfully managed medically, while 3 with either complicated sinusitis or sinusitis not responding to antibiotics were treated by endoscopic sphenoidotomy. All patients with a mucocele were treated surgically. Isolated inflammatory sphenoid sinusitis should be considered in children age 7 years or older who present with headache that does not respond to simple analgesia. Delayed diagnosis and advanced disease may lead to life-threatening complications.     

Endoscopic Sinus Surgery for Inflammatory Maxillary Sinus Disease

Objective/Hypothesis The role of endoscopic sinus surgery for treating chronic maxillary sinusitis is well established. The purpose of the study is to determine the efficacy of endoscopic sinus surgery in the treatment of maxillary sinus inflammatory disease that includes mucoceles, retention cysts, and antrochoanal polyps. Study Design This is a retrospective review of 32 consecutive patients who underwent endoscopic sinus surgery for mucoceles (n = 21), retention cysts (n = 5), or antrochoanal polyps (n = 6). Methods The medical records were reviewed for patient demographics, presenting symptoms, and type of operation. Surgical outcome was determined by resolution of symptoms, recurrence of disease, and need for revision or additional surgery. Results Ethmoidectomy with middle meatal antrostomy was performed in all patients; 28 patients had additional middle turbinectomy. Postoperative follow‐up ranged from 6 months to 4 years. The operation resulted in resolution of symptoms and a patent antrostomy on long‐term follow‐up in all cases of mucoceles. No case required revision surgery. On the other hand, the disease recurred in three patients (60%) with retention cysts and three patients (50%) with antrochoanal polyps despite patent antrostomies. The recurrences occurred 3 to 6 months after the surgery. The recurrent cases of antrochoanal polyps required Caldwell Luc procedures. The three failures in cases of retention cysts were successfully managed with repeated office endoscopic marsupialization through a patent antrostomy. Conclusions Endoscopic sinus surgery is an effective treatment for mucoceles, with favorable long‐term outcome. Maxillary retention cysts commonly recur after endoscopic sinus surgery. However, the recurrence can be managed in the office through a patent antrostomy. Endoscopic sinus surgery may be offered as initial surgical treatment for antrochoanal polyps, but a Caldwell Luc operation may be needed for recurrent disease.     

Computer-aided image-guided endoscopic sinus surgery in unusual cases of sphenoid disease

The vital neurovascular structures that border the sphenoid sinus make extensive sphenoid sinus surgery hazardous despite the advent of endoscopic sinus surgery (ESS). Computer-aided image-guided endoscopic sinus surgery (CAIGESS) has facilitated safer surgery by providing real-time analysis of complex, three-dimensional anatomic landmarks. We present 6 cases of atypical sphenoid disease, which greatly benefited from the unique superiority of CAIGESS in avoding surgical complications. Two cases of cerebrospinal-fluid (CSF) leak with concomitant meningoencephalocele of the sphenoid sinus were successfully managed with this technique. An inverting papilloma originating from the sphenoid sinus was successfully exenterated using CAIGESS. One patient, who experienced a lateral-rectus muscle palsy from sphenoid sinusitis, underwent successful sinusotomy with CAIGESS. Another patient, who had refractory left-sided sphenoid sinusitis despite 2 ESS procedures, was found to have an obliquely oriented intersinus septum which misled the previous surgeons to enter mistakenly the contralateral sphenoid sinus. CAIGESS allowed accurate identification and removal of the intersinus septum and relief of the sinusitis. Finally, a sphenoid-sinus mucocele that developed after a prior pituitary surgery was safely decompressed with CAIGESS. This surgical approach offers a new and effective adjunct to ESS in selected revision or difficult sinus cases and has proven invaluable in complicated sphenoid cases where the surrounding neurovascular anatomy could otherwise be jeopardized.     

鼻内窥镜手术治疗蝶、筛窦囊肿17例报告

目的：对鼻内窥镜手术治疗蝶、筛窦囊肿疗效进行评估。方法：回顾总结１７例鼻内窥镜手术治疗蝶、筛窦囊肿及３～９年随访的资料。结果：１７例在内窥镜下均良好暴露术野,术后囊腔得到充分引流;１５例获得满意疗效,无严重并发症发生。结论：鼻内窥镜下囊肿开放引流术是一种治疗蝶、筛窦囊肿安全、有效的方法