经鼻内镜开窗治疗上颌骨囊肿

目的探讨上颌骨囊肿的的治疗方法。方法根据囊肿的大小、累及上颌窦范围和离上颌窦自然开口距离,采用扩大上颌窦自然口中鼻道开窗3例、下鼻道开窗或鼻底开窗4例、泪前隐窝入路+下鼻道开窗9例,手术切除完全囊肿囊壁或部分切除,囊肿与上颌窦有间隔的将间隔完全去除,使囊肿与上颌窦融合为一个腔,保证囊肿腔与上颌窦、鼻腔引流通畅。结果术后随访6～24个月,平均随访12个月,15例面部胀感消失,未出现面部隆起,定期复查鼻内镜及鼻窦CT,囊肿术腔黏膜均于术后2～3个月上皮化,囊肿均无复发,术腔、鼻窦腔引流通畅。1例因开窗口小致开窗口闭合,但囊肿较前明显缩小,半年后再次开窗后囊肿未见复发。结论经鼻内镜开窗治疗上颌骨囊肿简便、安全、创伤小、恢复快、疗效确切、复发率低,术后便于观察术腔情况,尤其适合侵犯鼻腔底或上颌窦的上颌骨囊肿。     

上颌窦中鼻道窦造口术及窦壁成形术（摘要）

经Caldwell-Lue径路行上颌窦前壁环钻术，保留完整骨片。根治性或功能性清除上颌窦及筛窦的病变组织。改变下鼻道开窗为中鼻道窦造口术或自然孔扩大。修补窦前壁并把骨片对合复位，钻孔固定．完成窦壁成形术。术后结果表明．窦口开放率高．窦腔结构正常，复发率低。中鼻道窦口符合窦腔和窦口区纤毛流动方向，有利于生理性引流，窦壁成形修复完整窦腔为鼻窦生理功能提供了解剖生理环境。     

鼻内镜下泪前隐窝入路治疗上颌窦良性病变

目的经鼻内镜下泪前隐窝入路治疗上颌窦良性病变,并探讨其适应证、并发症及手术方式。方法回顾性分析43例经鼻内镜下泪前隐窝入路治疗上颌窦良性病变的病例,其中术前及术后病理确诊的上颌窦内翻性乳头状瘤15例,窦内病变镜下检出菌丝或孢子的真菌性上颌窦炎8例,上颌窦囊肿12例,上颌窦后鼻孔息肉6例,上颌窦异物2例。所有病例手术前均行鼻窦冠状位或水平位CT扫描。患者在局麻下以下鼻甲前缘为中心切口,解剖内移鼻泪管-下鼻甲瓣经泪前隐窝进入上颌窦腔处理上颌窦内病变,复位鼻泪管-下鼻甲瓣,缝合手术切口并行下鼻道开窗。结果 43例患者术中均完全清除窦内病变,术后随访6～24个月,下鼻甲形态愈合良好,术腔上皮化,无溢泪、面部麻木等并发症。2例上颌窦内翻性乳头状瘤术后6个月局部复发,原手术入路切除,随访1 8个月无复发。3例术后鼻腔粘连,局部分离,随访12个月无复发。结论经鼻内镜下泪前隐窝入路进入上颌窦是一种微创、安全、有效的处理上颌窦良性病变的手术方式,可作为鼻内镜下经中鼻道行上颌窦自然口开窗无法彻底切除窦内病变组织的首选治疗方法。     

鼻内镜下泪前隐窝入路处理医源性上颌窦异物

目的 探讨经鼻内镜下泪前隐窝入路处理医源性上颌窦异物的方法及疗效。方法 2012年1月至2014年6月为11例医源性上颌窦异物行鼻内镜下泪前隐窝开窗上颌窦异物取出术。结果 11例上颌窦异物均一次取出, 术后上颌窦自然口引流好, 黏膜愈合佳。术后随访3至6个月, 鼻腔、鼻窦恢复良好, 无并发症发生。结论 鼻内镜下泪前隐窝入路处理医源性上颌窦异物具有视野好、操作方便、损伤小、功能保护佳的优点, 处理巨大异物优势更明显。     

鼻内镜手术治疗上颌骨囊肿的临床分析

目的 探讨鼻内镜下经鼻-上颌窦进路切除上颌骨囊肿的手术方法及临床效果。 方法 回顾性分析自2014年3月至2019年4月收治的上颌骨囊肿患者21例,均为囊壁突入上颌窦内者,根据影像学检查明确囊肿的大小、范围以及与上颌窦各壁的位置关系,内镜下经鼻腔行扩大上颌窦自然口或联合泪前隐窝进路并下鼻道开窗引流,尽可能切除突入上颌窦腔的囊肿囊壁,使囊肿壁与上颌窦壁融合成共腔,建立囊肿-上颌窦-鼻腔相通的引流通道。 结果 所有患者术后随访6~24个月,术腔黏膜均上皮化良好,鼻面部症状消失或明显缓解,囊腔与上颌窦引流通畅,无复发病例。 结论 经鼻-上颌窦进路切除或开放上颌骨囊肿联合下鼻道开窗引流,可以彻底切除病变或建立充分的引流通道。相对于传统手术进路刮除或开放囊肿,该进路损伤轻微、恢复快、复发率低,符合微创手术的理念,值得临床推广。     

鼻内镜下犬齿窝径路治疗上颌窦病变

目的：探讨一个损伤少,方便快捷且效果好的鼻内镜下的上颌窦手术方案治疗上颌窦病变。方法：2002年3月至今,设计在患侧唇龈沟第三齿上方做一纵形切口1～1.5cm,分离至犬齿窝骨质,用骨凿或电钻做1cm左右的骨孔,清除此处的上颌窦黏膜,置入鼻内镜,检查上颌窦内的病变情况,如果为上颌窦黏膜下囊肿,去除囊壁,妥善止血;上颌窦自然窦口正常者,无须扩大窦口,在上颌窦内的创面上和犬齿窝骨窗处贴附止血纱布,缝合2针,也可以应用耳脑胶粘合。如果为上颌窦息肉,处理方法基本同上颌窦囊肿。如果为上颌窦曲菌病,就需要扩大上颌窦自然窦口1～1.5cm,鼻腔内可不必填塞,如需扩大自然窦口,可填塞膨胀海绵。结果：36例均一期愈合,鼻腔通畅,症状消失,经过4个月～4年的随访观察,未见病变复发,仅2例有短暂的唇部麻木,7～8d后康复。2例扩大自然窦口处有肉芽生长,经处理后肉芽消失。结论：本术式有视野清晰,处理病变方便,并发症少,不宜发生严重的反应,窦口引流自然,符合上颌窦黏膜的正常生理特点。     

鼻内镜下中鼻道联合泪前隐窝入路治疗真菌性上颌窦炎

目的 探讨鼻内镜下经中鼻道上颌窦自然口扩大联合泪前隐窝入路治疗真菌性上颌窦炎的适应证及疗效。 方法 回顾分析2008年6月至2014年6月行鼻内镜下经中鼻道上颌窦自然口扩大联合泪前隐窝入路治疗真菌性上颌窦炎32例患者的临床资料,分析联合入路的适应证、疗效及并发症。 结果 患者均完整彻底清除病变,无并发症发生。随访1年半以上,均无复发。 结论 鼻内镜下经中鼻道上颌窦自然口扩大联合泪前隐窝入路视野清晰,对上颌窦暴露充分,上颌窦霉菌清除彻底,创伤小,疗效确切,可作为鼻内镜下经中鼻道行上颌窦扩大或辅助下鼻道开窗仍无法彻底清除窦内霉菌的首选方法。     

鼻内窥镜下微波辅助治疗上颌窦息肉及囊肿

目的：探讨鼻内镜下利用微波热凝治疗上颌窦息肉及囊肿的疗效。方法：对67例上颌窦息肉及囊肿患者行鼻内镜下微波辅助鼻窦手术，在30°、70°鼻内窥镜引导下，利用微波辐射器可随意弯曲的特点，将微波探头经扩大的上颌窦口伸入窦内热凝窦内息肉和囊肿，彻底清除病变。需扩大上颌窦口者同时用微波行中鼻道上颌窦造口术。结果：术后随访6～12个月（平均9个月），治愈58例，好转8例，无效1例。总有效率98.5％，治愈率86.6％。结论：此法可彻底清除上颌窦内病灶，降低术后复发率，弥补了经鼻内窥镜鼻窦手术在处理上颌窦病变时的局限性。     

鼻内镜下鼻腔内外侧壁入路治疗涉及上颌窦的良性病变

目的探讨鼻内镜下鼻腔外侧壁切开入路治疗涉及上颌窦良性病变的手术方法和临床价值。方法回顾分析15例累及上颌窦的良性病变病例,鼻内镜直视下先从下鼻甲前缘行鼻腔外侧壁切开,解剖出鼻泪管后形成鼻泪管-下鼻甲瓣,彻底清除上颌窦病灶,并处理鼻腔及其他鼻窦等病变,最后复位鼻泪管-下鼻甲黏膜瓣,必要时行下鼻道开窗。结果所有患者术后均经病理证实为良性病变,排除恶性肿瘤。随访6个月至2年,术腔上皮化,下鼻甲形态良好,病变无复发,均无面颊部麻木、溢泪等并发症。结论鼻内镜下鼻腔内外侧壁切开并保留鼻泪管和下鼻甲,有利于整个上颌窦腔病变彻底清除和方便处理累及翼腭窝颞下窝病变,有一定的临床价值。     

上颌窦囊肿手术进路的选择

目的探讨鼻内镜下3种摘除上颔窦囊肿进路的选择。方法本组上颌窦囊肿共32例,术前均经鼻窦CT扫描和鼻内镜检查,明确鼻腔情况、囊肿的大小及位置。其中8例伴鼻窦炎鼻息肉者,经中鼻道自然口开放术进路行Messerkling术;19例单纯上颌窦囊肿患者,鼻内镜下经改良柯-陆进路行囊肿摘除术,另5例采用下鼻道开窗进路行囊肿摘除术。结果术后随访6个月～1年,鼻窦CT冠状位扫描或鼻内镜检查,19例经改良柯-陆进路者术后无复发;8例经中鼻道自然口开放术进路者,2例复发,1例术后窦口闭锁,中鼻甲与鼻腔外侧壁粘连;5例经下鼻道开窗进路者,1例复发,2例失访。结论3种术式各有优缺点,临床中应根据不同情况酌情选用。     

鼻内开窗术治疗巨大上颌骨囊肿的临床察

目的探讨鼻内开窗术治疗巨大上颌骨囊肿的临床疗效。方法选择术前穿刺并且经鼻窦CT及MRI检查诊断为上颌骨囊肿的患者5例,囊肿均大于3.5 cm,所有患者采用鼻内镜下鼻内开窗术,根据囊肿与鼻腔、鼻窦的毗邻关系,分别选择鼻底开窗术、下鼻道开窗术,必要时行泪前隐窝开窗术,手术切除囊壁,其中2例患者因囊肿局限、主要靠近鼻底而选择单纯鼻底开窗术;2例患者因囊肿波及上颌窦内而选择下鼻道开窗术,其中1例术前因牙痛就诊,术后建议拔除患牙;1例患者因囊肿位置特殊,靠近上颌窦前壁因而行下鼻道开窗术联合泪前隐窝开窗术,对位缝合切口,术后予以碘仿纱条压迫及盐水冲洗,清理术腔,保证开窗口通畅引流。结果5例患者均未出现严重并发症,术后3个月左右囊腔上皮化,术后随访半年,窗口引流通畅,未见复发。结论鼻内开窗术是一种简单并且常用的手术方式,具有出血少、创伤小、复发率低等优点,保证开窗口通畅引流是减少上颌骨囊肿复发的关键。     

慢性上颌窦炎鼻内镜下开窗方式的选择与疗效观察

目的观察鼻内镜下上颌窦开放术治疗慢性上颌窦炎,不同开窗方式的选择与疗效分析。方法 56例单侧慢性筛、上颌窦炎伴鼻息肉患者,术前Lund-Mackay CT评分,CT评分=2者纳入研究对象,术中随机分为A组28例、B组28例,分别行中鼻道开窗和中下鼻道联合开窗,以鼻腔鼻窦结局测试-20（sino-nasal outcome test-20,SNOT-20）量表中文版、Lund-Kennedy评分及糖精试验黏液纤毛传输时间（mucociliary transport time,MTT）对比术后疗效,另外,用亚甲蓝染色观察黏液纤毛传输途径。结果术后6个月时,A、B两组SNOT评分、Lund-Kennedy评分及MTT值差异均有统计学意义（P〈0.05）;50例亚甲蓝从上颌窦口下缘流出,5例亚甲蓝从上颌窦口前缘流出。结论①对于慢性上颌窦炎Lund-Mackay CT评分=2的病例,行中、下鼻道联合开窗可取得更好的疗效;②上颌窦口下缘黏膜是黏液纤毛传输的重要途径,对上颌窦的引流起着极为重要的作用。     

不同手术入路治疗上颌窦真菌性鼻窦炎94例的临床分析

目的探讨不同手术入路治疗上颌窦真菌性鼻窦炎的临床疗效。方法回顾性分析94例上颌窦真菌性鼻窦炎患者的临床资料,分别采用3种手术径路,即柯一陆手术入路31例、鼻内镜上颌窦窦口开放入路33例、鼻内镜上颌窦窦口开放联合下鼻道开窗入路30例;比较不同术式的临床疗效。结果所有患者术后均随访12个月。其中采用柯-陆手术入路患者治愈率74．2％（23／31）,5例出现面部麻木,无溢泪及鼻腔粘连等并发症;采用鼻内镜上颌窦窦口开放人路患者治愈率81．8％（27／33）,7例患者出现鼻腔粘连,鼻内镜下直接分开后好转,无溢泪及面部麻木等症状;采用鼻内镜上颌窦窦口开放联合下鼻道开窗入路患者治愈率100％,5例患者出现鼻腔粘连,鼻内镜下直接分开后好转,无溢泪及面部麻木等并发症。结论鼻内镜上颌窦窦口开放联合下鼻道开窗入路是一种微创、安全、有效的治疗上颌窦真菌性鼻窦炎的手术方式。     

Implications of endoscopic endonasal surgery for the treatment of postoperative maxillary mucoceles

Recently, endoscopic endonasal surgery has been widely used to treat chronic sinusitis with good results being reported by many investigators. Endoscopic endonasal surgery is a technique available not only for chronic sinusitis but also for other sinus diseases including postoperative maxillary mucoceles. In this report, the indications and limitations of endoscopic endonasal surgery for the treatment of postoperative maxillary mucoceles are discussed based on our experience treating 26 such mucoceles at our clinic. The indications for endoscopic endonasal surgery include mucoceles in close contact with the lateral wall of the inferior nasal meatus and those mucoceles that can be widely opened to the middle nasal meatus. The following cases could not be treated by endoscopic endonasal surgery: mucoceles that were localized in areas distant from the nasal cavity, mucoceles in which the lateral wall of the inferior nasal meatus was bony and intensely thickened, and mucoceles that could not be sufficiently opened to the middle nasal meatus.     

鼻内镜下上颌窦良性病变的手术治疗

目的:探讨鼻内镜下上颌窦良性病变的手术切除方法.方法:41例上颌窦息肉、囊肿、曲菌病、内翻性乳头状瘤等良性病变,分别采用3种不同的手术方式清除病灶,其中30例经扩大的上颌窭自然开121径路;4例经鼻内中、下鼻道双径路;7例经扩大的上颌窦自然开口及鼻腔外侧壁切除双径路.结果:术后随访6个月以上,治愈39例,2例复发,治愈率95.1%.结论:鼻内镜下经鼻腔采用3种不同的手术径路切除上颌窦良性病变,疗效肯定,创伤小,值得临床推广.     

Functional endoscopic sinus surgery

Summary The Messerklinger technique is a primarily diagnostic endoscopic concept demonstrating that the frontal and the maxillary sinuses are subordinate cavities. Disease usually starts in the nose and spreads through the ethmoidal prechambers to the frontal and maxillary sinuses, with infections of these latter sinuses thus usually being of secondary nature. Standard rhinoscopy and sinus X-rays are frequently not sufficient to demonstrate the underlying causes for chronic or recurring acute sinusitis in the clefts of the anterior ethmoidal sinuses. The combination of diagnostic endoscopy of the lateral nasal wall with conventional or computed tomography in the coronal plane has proven to be the ideal method for the examination of inflammatory diseases of the paranasal sinuses. In so doing, diseases and lesions that other-wise might have gone undiagnosed can be identified and consequently treated. Based on this diagnostic approach, an endoscopic surgical concept was developed, aiming for the underlying causes of sinus diseases instead of the secondarily involved larger sinuses. With usually very limited surgical procedures, diseased ethmoid compartments are operated on, stenotic clefts widened and prechambers to the frontal and maxillary sinuses freed from disease. In our experience, there is rarely a need for major manipulations inside the larger sinuses per se. Based on exact diagnosis, the surgical technique used allows a very individualized staging according to the prevailing pathology. In the extreme, a total sphenoethmoidectomy can be performed with this technique, although the true advantage of the technique is that even in cases of massive disease such radical procedures can be avoided. By reestablishing sinus ventilation and drainage via the natural ostia, there is also no need for fenestration of the inferior meatus. The Messerklinger technique can be applied to a wide spectrum of indications, apart from nasal polyposis. The technique has its clear limits as well as its specific problems. Adequate training and experience are required for the surgical approach, as the technique bears all the risks and hazards of all kinds of endonasal ethmoid surgery but has a minimal complication rate in the hands of an experienced surgeon. Results and complications of a series of more than 4500 patients over a period of over 10 years are presented and discussed in detail.Dedicated to Professor W. Messerklinger on the occasion of his 70th birthdayoffprint requests to: H. Stammberger     

Endoscopic endonasal sinus surgery for post-operative maxillary cysts

Surgical treatment for postoperative maxillary cysts uses a Caldwell-Luc or endonasal approach. Endoscopic endonasal surgery has become the treatment of choice in postoperative maxillary cyst, and many postoperative maxillary cysts have been classified. Due to the importance of cyst medial wall sites, we classified cysts into 4 types by location. Those whose, medial wall was close to the middle meatus, inferior meatus, or nasal lateral wall, we termed middle meatus, inferior meatus, and nasal lateral wall types. When the lateral cyst was not close to the nasal cavity but to another cyst, we termed the cyst continuous. We opened all nasal cavity cysts as far as possible. For continuous types, we determined location of the lateral cyst 3-dimensionally before surgery. We first opened medial cysts and opened the lateral cyst through the medial cyst. The tube was placed the lateral cyst to the nasal cavity. We opened all 45 cysts in 29 patients to the nasal cavity. As of this writing, no cysts connected to the nasal cavity have recurred.     

Endoscopic trans-nasal-vestibular approach to the maxillary sinus--application for mucoceles of the maxillary sinus.

Endoscopic endonasal surgery has been applied to the treatment of paranasal mucoceles. The approach is, however, hard to be adopted for maxillary mucoceles when the cyst is situated in the anterior and/or lateral portion of the maxillary sinus, has a thick bony lateral wall of the inferior nasal meatus, and when the patients develop compartmentalized cysts following facial trauma or sinus operation. We devised an endoscopic approach via the vestibule of the nose to reach any part of the maxillary sinus and applied it for the treatment of postoperative maxillary mucoceles, which could not be opened following the usual endoscopic approach with favorable outcomes.     

慢性鼻窦炎鼻内镜手术后近期失访患者的远期疗效评估

目的：探讨慢性鼻窦炎鼻内镜鼻窦手术后3个月内失访患者的远期疗效及影响因素。方法：收集153例鼻内镜鼻窦手术后1年以上且术后3个月内失访患者的临床资料,对其进行追踪调查,评价其远期疗效。分析患者的临床资料,包括：性别、年龄、文化程度、病程、吸烟、饮酒、前期手术史、变应性鼻炎、是否伴有鼻息肉、视觉模拟量表评分、鼻内镜检查评分、CT检查评分、手术医生的内镜手术经验（年限）、术后鼻用糖皮质激素使用、术后鼻腔冲洗等,对结果进行Logistic回归分析。结果：153例患者远期疗效评定,病情完全控制32例（20.9%）,病情部分控制74例（48.4%）,病情未控制47例（30.7%）。经多因素Logistic回归分析,CRS不伴鼻息肉、不伴变应性鼻炎、无前期手术史、CT评分在5分以下、由内镜手术经验在5年以上的医生手术、术后鼻用糖皮质激素使用超过4周的失访患者的临床疗效优于相应组别的患者,均差异有统计学意义（均P〈0.01）。结论：慢性鼻窦炎患者鼻内镜手术后应强调随访的重要性,并根据患者的病情制定相应的随访计划,部分病变轻、手术适当的患者可减少或不做术腔处理。     

鼻内镜下上颌骨囊肿开放术

目的:探讨鼻内镜下上颌骨囊肿开放术的有效性和可行性。方法:对13例侵犯上颌窦或鼻腔底的上颌骨囊肿在鼻内镜下行上颌骨囊肿开放术,即行鼻内镜下囊肿下鼻道或鼻腔底开放术,囊肿囊壁被全部或部分切除。结果:随访6～36个月,13例患者未出现面部隆起、鼻塞及鼻腔溢液等症状,囊肿无复发。结论:鼻内镜下上颌骨囊肿开放术适用于侵犯上颌窦或鼻腔底的上颌骨囊肿,较传统手术创伤小,简单高效,受侵牙齿可尽量保存。