鼻内镜下造口术治疗侵入眼眶的鼻窦黏液囊肿

目的：研究鼻内镜下造口术治疗侵入眼眶的鼻窦黏液囊肿和术后处理方法及长期疗效。方法：对24例侵入眼眶的鼻窦黏液囊肿患者,均采用鼻内镜下造口术;术后按内镜鼻窦手术后的常规处理,重点是防止中鼻道粘连及窦口再狭窄和促进窦口上皮化。结果：随访1～5年。24例患者术后均无囊肿复发,无眶内并发症,眼球复位。结论：鼻内镜下造口术治疗侵入眼眶的鼻窦黏液囊肿,无复发和并发症,是一种值得推荐的手术方式;术后处理的重点是防止中鼻道粘连及窦口再狭窄和促进窦口上皮化;长期复查是必要的。     

内镜下治疗侵及眼眶的鼻窦黏液囊肿临床分析

鼻窦黏液囊肿是一种缓慢生长的囊性病变,囊肿的持续膨胀生长可侵及整个窦腔,甚至多个窦腔,向周围延伸出现并发症。蝶额筛区黏液囊肿可向颅底及眼部侵犯,如不及时诊断、引流,会导致严重并发症。我院2007—01—2010-01采用鼻内镜手术治疗侵及眼眶的鼻窦黏液囊肿12例,取得了良好的治疗效果,现报告如下。     

经鼻内镜手术治疗鼻窦黏液囊肿27例

鼻窦黏液囊肿的传统手术多采用鼻外径路、上颌窦根治术径路,且尽可能完整切除囊壁。随着鼻内镜手术的广泛开展,现多采用鼻内镜手术治疗。手术尽可能保证足够开放引流为原则。笔者介绍27例鼻窦黏液囊肿的鼻内镜手术治疗。     

伴视力减退的鼻窦黏液囊肿的临床诊断和治疗

目的:总结引起视力减退的鼻窦囊肿的临床表现和治疗要点。方法:回顾性研究2002-2010年间收治的伴有视力下降的鼻窦囊肿患者23例,其中累及额窦或额筛窦10例,单纯累及筛窦6例,累及蝶窦或蝶筛窦7例。患者常以眼部症状为主,因此大多数首诊于眼科。因蝶窦与视神经紧密相邻,蝶窦和蝶筛窦囊肿引起严重视力障碍较其他窦腔囊肿更严重。CT和MRI是确诊鼻窦黏液囊肿的重要手段。对患者实施鼻内镜手术,开放鼻窦开口,清除窦腔内囊肿及行视神经减压。术后均使用激素治疗并常规行鼻内镜复查。结果:术后所有患者眼部突出、复视、眼球运动障碍等症状好转,但视力恢复程度不一,与手术时机和视力下降严重程度有关。未及时手术者视力恢复效果较差,而视力完全丧失无光感者,即使行视神经管减压术,预后仍明显低于有残余视力者。结论:鼻内镜手术是治疗伴视力减退的鼻窦囊肿的有效手段,提高对该病的警惕和早期影像学检查对于其诊断非常重要,早期诊断和及时手术治疗是恢复患者视力的关键。     

丝裂霉素C在鼻窦囊肿手术中的应用

经鼻内镜鼻窦囊肿手术,失败的主要原因是窦口阻塞致囊肿复发。因此,鼻窦囊肿手术后常需留置胶管于窦口防止阻塞,但这会给患者的生活带来不便。我们在手术中应用丝裂霉素C（MMC）,解决了窦口置管给患者带来的诸多不适,并能预防窦口的粘连和阻塞,取得了满意疗效。现报告如下。     

导航鼻内镜下治疗鼻窦囊肿

目的 探讨应用影像导航系统在鼻内镜下治疗鼻窦囊肿的方法及优势。方法 在导航鼻内镜下对121例鼻窦囊肿施行手术,其中上颌窦黏液囊肿12例,上颌窦黏膜囊肿5例,筛窦黏液囊肿43例,额窦黏液囊肿29例,蝶窦黏液囊肿32例。均采用气管插管全麻,根据手术中的需要标定探针或吸引器作为术中的定位设备,在鼻内镜下使用导航定位设备以判断囊肿的准确位置,根据术中探针的指引通过最短的距离到达囊肿,完整或部分切除囊壁,通畅引流。结果 121例手术均准确定位了囊肿的位置,完成手术, 无术中、术后并发症发生。结论 影像导航系统结合鼻内镜治疗鼻窦囊肿具有定位准确、手术创伤小的优点,可以有效地提高手术疗效和避免并发症的发生。     

鼻窦恶性肿瘤侵犯眼眶的手术治疗

筛窦、上颌窦恶性肿瘤向外上扩展可侵犯眼眶至眶内 ,致使眼球突出、视力障碍、溢泪 ,并可累及邻近组织 ,甚至破坏颅底骨质侵入脑膜 ,给治疗带来一定困难。手术中如何处理眶内及邻近组织的病变 ,直接关系到手术的成功和患者的预后。 1 984～1 995年 ,我科收治此类患者 1 4例 ,均经手术治疗 ,取得一定的临床经验。报告如下。1　临床资料1 4例窦眶恶性肿瘤患者 ,男 9例 ,女 5例 ;年龄2 1～ 68岁。病程 6～ 1 8个月。主要临床表现为鼻塞、涕血 ;面部畸形 ,眼球突出 ,运动障碍。其中 ,筛窦 9例 ,上颌窦 5例。CT扫描提示筛窦、上颌窦内有占位性病…     

鼻窦-眼眶骨折的处理体会

颅面部骨折常引起鼻窦一眼眶、颅底及颌骨等多处骨折,病情处理与耳鼻咽喉科、眼科、口腔科及颅脑外科等多科相关。1997年10月～2004年8月我科收治鼻窦一眼眶骨折患者8例,现报告如下。     

经鼻内镜治疗侵犯眼眶及颅内的额窦黏液囊肿

目的探讨应用鼻内镜治疗侵犯眼眶及颅内的额窦黏液囊肿的手术方法及疗效。方法回顾性分析侵犯眼眶及颅内的额窦黏液囊肿7例。7例病变均破坏眶上壁及内壁,3例同时破坏额窦后壁侵犯颅内。经鼻内镜行额窦口扩大术,切除部分窦口周围囊肿壁,保留与眶骨膜及硬脑膜紧密的部分囊肿壁。术后鼻腔清理半年,保证囊肿腔与鼻腔引流通畅。结果1例视力下降者术后视力无明显提高,其余患者眼球突出、复视、视力下降、头痛及眶痛等症状均在3个月内逐渐消失。无颅内出血、脑脊液漏及颅内、眶内感染等术后并发症。术后随访1年,鼻内镜复查窦腔引流通畅,无鼻窦囊肿复发。结论应用鼻内镜额窦口扩大术治疗侵犯眼眶及颅内的额窦黏液囊肿手术安全、有效。保持额窦口黏膜光滑、引流通畅,是防止囊肿复发的关键。     

鼻窦脓囊肿13例报告

鼻窦脓囊肿１３例报告唐世雄１鼻窦脓囊肿临床少见，容易和其它疾病混淆。我科１９８３～１９９６年收治１３例，现报告如下。１临床资料１１一般资料１３例中，男８例，女５例，年龄２８～７２岁，平均年龄４５岁，从出现症状至本科就诊时间为１个月～１年。脓囊肿位...     

Maxillary sinus mucoceles: clinical presentation and long-term results of endoscopic surgical treatment.

OBJECTIVE: To describe the clinical presentation of maxillary sinus mucoceles, understand their pathogenesis, and determine the long-term efficacy of the endoscopic surgical treatment. STUDY DESIGN: Retrospective review. METHODS: Thirteen consecutive patients who presented with maxillary sinus muco(pyo) celes were studied. Subjects with history of preceding sinus/nasal surgery or facial trauma were excluded. The presenting signs and symptoms, radiological findings, and surgical management were reviewed. RESULTS: There were six women and seven men with an age range of 31 to 71 years. Two patients had environmental allergies. Nine patients complained of cheek pressure or pain, six of nasal obstruction, and eight of nasal drainage. On endoscopic nasal examination, the medial wall of maxillary sinus was bulging with prolapsed middle meatal mucosa in 10; drainage was seen in 7, but none had polyps. The sinus involvement was limited to the maxillary sinus and the ipsilateral ethmoid on computed tomographic studies in 10 cases. Patients were treated with endoscopic ethmoidectomy, middle meatal antrostomy, and marsupialization of the mucocele. Intraoperative cultures grew organisms in five patients. Postoperative follow-up ranged between 10 and 66 months. Two patients required lysis of adhesions in the middle meatus, and one, revision antrostomy. All patients had a patent middle meatal antrostomy and healthy maxillary sinus mucosa at latest follow-up. The presenting symptoms resolved or improved in 12 cases. CONCLUSIONS: The etiology of maxillary sinus mucoceles is not well understood. Mechanical obstruction or allergy or both do not seem to play an important role. An infectious origin is also not supported by the above data. Endoscopic sinus surgery is a reliable therapeutic measure with a favorable long-term outcome.     

鼻内镜下额筛窦骨瘤切除术

目的：评价额筛窦骨瘤鼻内镜径路切除术的效果。方法：18例额筛窦骨瘤患者中,位于额窦者8例,筛窦者6例,起源于筛窦突入额窦者4例,骨瘤大小为1cm×1cm×1cm～1．5cm×3．0cm×4．0cm,单纯采用鼻内镜径路切除17例,鼻内镜联合鼻外径路切除1例。结果：全部患者均完整切除肿瘤,无脑脊液鼻漏和眶筋膜损伤等并发症。术后随访6个月～3年,术前症状消失,未见复发。结论：对于额筛窦骨瘤,通过鼻内镜必要时结合眉弓切口外径路手术能够完整切除,并能够保护颅底、额窦后壁以及眶纸板等重要结构免受损伤。     

与鼻内镜上颌窦手术视野相关的上颌窦形态特征

目的：观察与鼻内镜上颌窦手术视野相关的上颌窦形态特征。方法：通过对1000例（2000侧）正常成人的鼻窦CT（轴位＋冠状位）扫描,观察其上颌窦形态并进行分型。结果：CT显示上颌窦与手术相关的形态变化主要在其内侧壁,水平位鼻窦CT显示上颌窦内侧壁的形态在中部较恒定,一般都呈现以内侧壁为底边的三角形或半圆形,前者有857例（85．7％）,后者有143例（14．3％）;冠状位显示上颌窦内侧壁形态前、后层面较为恒定,中间层面的差异较大,有外凸形和平直形,其中外凸形341例（34．1％）,平直形659例（65．9％）。根据中间层面内侧壁的形态及上颌窦气化程度将上颌窦形态分为三型：I型662例（66．2％）,Ⅱ型265例（26．5％）,Ⅲ型73例（7．3％）。结论：上颌窦内侧壁形态影响鼻内镜中鼻道人路的上颌窦手术视野,在鼻内镜上颌窦手术前应充分考虑其形态对于手术视野及病变的清除的影响。     

Outcomes of frontal mucoceles treated with conventional endoscopic sinus surgery

Conclusion: Conventional endoscopic sinus surgery (CESS) is useful for frontal mucoceles. A patient with short anterior–posterior distance and bone thickening may need an axillary flap, Draf type IIb, or Draf type III procedure. Objective: To present outcomes of frontal mucoceles treated with CESS and predict risk factors for poor outcomes to help define surgical indications. Methods: A consecutive clinical series was reviewed retrospectively. The authors performed CESS without agger nasi resection (Draf type IIa) for 13 frontal sinus mucoceles in 12 patients between October 2011 and July 2013. Patient age, sex, blood eosinophil count, history of operation and co-existence of acute infection were compared. For the condition of the frontal sinus, anterior–posterior distance and width of frontal recess, bone thickening of the frontal recess, bone absorption due to continuous pressure by mucocele and anatomy of the frontal recess was noted. Results: All operations were done without a navigation system. The post-operative course was uneventful in all 12 patients, and all symptoms gradually receded. Among 13 mucoceles, one frontal sinus (7.7%) closed during follow-up.     

Paranasal sinus mucoceles with visual disturbance

Objective

Paranasal sinus mucoceles may cause visual disturbance in patients because of their close proximity to the orbit. We aimed to investigate visual prognosis to determine whether it is influenced by the interval before surgery and the severity of visual disturbance, and to heighten the physician's awareness of the occurrence of this disease.

Methods

We retrospectively reviewed eight surgically treated patients with paranasal sinus mucoceles accompanied by visual disturbances between March 2005 and January 2009, and examined the visual acuity outcome of the patients.

Results

Four patients with a mild visual acuity loss showed improvement after surgical drainage within 1 month after onset. Two patients with visual disturbances persisting for more than 1 year did not show postoperative improvements. Although two patient's preoperative visual acuity loss was worse than the ability to count fingers, they showed a remarkable improvement after surgery.

Conclusions

These results show the importance of diagnosing and treating paranasal sinus mucoceles with visual disturbance as soon as possible. In addition, the improvement of visual acuity can be expected if surgery is performed within 1 month after onset, and the patient's preoperative visual acuity loss is mild. However, if patients with severe visual acuity loss consult otolaryngologists at a later date, surgery may still be considered worthwhile.     

鼻颅底沟通性肿瘤的诊断及外科治疗

目的 探讨鼻颅底沟通性肿瘤的诊断及外科治疗方法。方法 回顾性分析2011年1月—2021年12月华中科技大学同济医学院附属同济医院神经外科诊治的37例鼻颅底沟通性肿瘤的临床资料,男23例,女14例;年龄6~67岁,平均年龄49岁。其中恶性肿瘤27例,良性肿瘤10例,肿瘤直径4.7~8.5 cm,平均直径6.3 cm。所有患者均采用头颈部影像学检查协助诊断后行开颅显微手术+颅底重建,恶性肿瘤术后进一步行放化疗,术后所有患者均定期随访,恶性肿瘤随访5~10年,平均8.3年;良性肿瘤随访1~11年,平均6.7年。结果 所有患者均顺利完成手术,无严重并发症,恶性肿瘤5年生存率63.0%(17/27);1例良性肿瘤(非典型脑膜瘤)术后5年复发再次经双侧额底入路手术治疗。结论 神经外科首诊的鼻颅底沟通性肿瘤往往颅内肿瘤为主体,开颅手术全切或大部分切除+妥善颅底修复意义重大。     

单侧鼻腔鼻窦病变诊断的有关问题

单侧鼻腔鼻窦病变表现多样化,值得引起重视。近年来,随着鼻内镜技术的推广及普及,越来越多的医疗单位开展了鼻内镜手术,也面临着许多鼻腔鼻窦疾病的诊治问题,由于诊断不准确甚至误诊,导致治疗不当或准备不充分致手术被动,或被迫终止手术,由此出现一些不该发生的问题,给患者造成了不必要的损失,增加了患者的痛苦和负担,影响了疾病的预后,甚至造成了不可挽回的后果。单侧性鼻腔鼻窦病变临床上并非罕见,其病理变化多样,临床表现复杂,容易产生漏诊、误诊,有时引起严重后果。因此,对单侧鼻腔鼻窦病变的病理类型、临床特点、影像学表现予以分析总结,有助于增进对此类病变的认识,提高诊治水平。