上颌骨动脉瘤样骨囊肿的诊断与治疗 (附4例报告及文献复习)

目的：探讨上颌骨动脉瘤样骨囊肿的诊断与治疗。方法：4例上颌骨动脉瘤样骨囊肿患者，1例在局部麻醉下行上颌窦根治术，3例在全身麻醉下行鼻侧切开术。结果：术后随访13个月～2年均无复发。结论：动脉瘤样骨囊肿以根治性手术切除为主，力求彻底。术前DSA检查确认瘤体供血动脉并栓塞，对减少术中出血和缩短手术及全身麻醉时间有显著作用。     

上颌窦动脉瘤样骨囊肿1例

动脉瘤样骨囊肿(aneurismal bone cyst，ABC)是一种少见的骨瘤样病变，病因不明。主要发生于脊椎骨和长管状骨，罕见于扁骨及颅面骨。1997年6月我科遇到1例原发于右上颌窦的动脉瘤样骨囊肿．现报告如下。     

上颌窦动脉瘤样骨囊肿1例

患者,男,13岁,因右侧面部隆起伴疼痛、右侧眼球突出1年余,于2004年2月20日人院。体检：T36．4℃,P90次／min,R20次／min,BP105／60mmHg（1mmHg=0．133kPa）。发育正常,营养中等;头颅无畸形,双侧眼睑无水肿,右眼球向前突出,眼球运动自如,双侧瞳孔等大等圆,对光反射灵敏,视力正常。心、肺、腹未见异常。血、尿常规,肝、肾功能,乙肝5项,PT,心电图,X线胸片检查均未见异常。专科检查：右侧面颊部隆起,右鼻腔外侧壁内移,中鼻道有少许黏涕,鼻腔通气欠佳,鼻中隔左偏,左侧鼻腔未见异常。     

上颌窦动脉瘤样骨囊肿

本文在国内首次报告1例上颌窦动脉瘤样骨囊肿。结合文献复习,认为本病的临床特点主要是患侧面颊部肿胀、鼻塞进行性加重和由此引起的继发症状;B超和CT检查有助于诊断;治疗多以手术切除为主。并就其发病机理和鉴别诊断进行讨论。     

颌面蔓状血管瘤继发上颌骨动脉瘤样骨囊肿1例

临床资料,患者男,17岁。因右面部肿胀三年入院。起始表现为右颊部无痛性肿胀。当地医院经CT及双颈外动脉造形检查诊断为血管瘤,行“右颈外动脉分支栓塞术”,术后颊部肿瘤基本消失;两年后,右眶下渐隆起,始为较组织肿瘤,渐变成质软和质硬混合性肿瘤,轻度疼痛,右眼抬高并出现复视。     

上颌窦动脉瘤样骨囊肿(附3例报告)

目的探讨上颌窦动脉瘤样骨囊肿的临床特征与治疗方法.方法回顾分析3例上颌窦动脉瘤样骨囊肿的相关文献,总结其临床表现、影像学特点及治疗效果.结果上颌窦动脉瘤样骨囊肿常见的症状为瘤体呈膨胀性生长、局部肿痛及临近器官压迫症状,较为特异的是穿刺有高压不凝血液喷出,影像学检查有助于诊断,3例患者均行手术切除,随访3～5年无复发.结论上颌窦动脉瘤样骨囊肿的X线征象表现为"气球样、皂泡样"改变,治疗应首选手术.     

鼻腔鼻窦黏液表皮样癌1例并文献复习

黏液表皮样癌是来源于大唾液腺的低度恶性肿瘤。其恶性程度主要取决于它的组织成分。一般认为黏液细胞多 ,其恶性程度低 ;表皮细胞多 ,其恶性程度高〔1〕。主要发生于腮腺、口腔小涎腺、腭部、颌下腺 ,发生于鼻腔鼻窦黏液表皮样癌较为少见。我科 2 0 0 1年 1 2月收治 1例 ,现分析报告如下。1　临床资料患者 ,男 ,47岁。 1 0年来反复左鼻塞 ,流脓涕 ,自行服药后缓解。近 1d来上述症状加重 ,且头痛剧烈 ,于 2 0 0 1年 1 2月 1 3日收入我院。X线片示 :左侧额窦、筛窦及上颌窦炎。发病以来 ,无鼻出血或涕中带血 ,无嗅觉障碍及面颊麻木、肿胀 ,…     

鼻腔巨大骨囊肿1例

鼻腔骨囊肿临床少见,位于鼻腔、波及鼻窦及前颅窝者更少见。我科于2004年2月21日收治1例,报告如下。     

原发性鼻腔-鼻窦砂粒体型脑膜瘤1例报道并文献复习

目的 通过报道1例原发于鼻腔-鼻窦砂粒体型脑膜瘤患者的临床资料及相关文献复习,以提高临床医师对该病的认识及诊疗水平.方法 患者,女,50岁,因"渐进性右侧鼻塞1年余"入院.术前影像学检查提示右侧鼻腔及筛窦内不规则占位性病变,遂在全麻鼻内镜下行右侧鼻腔筛窦肿物切除术.结果 肿物完全切除,术后病理及免疫组化确诊为砂粒体型脑...     

鼻腔鼻窦粘液表皮样癌误诊为慢性鼻窦炎1例

病人,男,47岁,因反复左鼻塞、流脓涕10年,加重伴头痛1d入院。病人10年来反复左鼻塞,流脓涕,其间自行服药症状有所缓解。近来上述症状加重,出现剧烈头痛。于2001年12月13日来我院诊治,门诊摄鼻窦片示:左侧额窦、筛窦及上颌窦窦腔昏暗,窦腔缩小,诊断:左侧额窦、筛窦及上颌窦炎。为进一步诊治以慢性鼻窦炎收入院。体检:体温36.4℃,无面颊肿胀,无眼球移位,眼球各方向活动好,无视力障碍及复视。鼻外观无畸形,左中鼻道可见脓涕,鼻腔未     

Aneurysmal bone cyst of paranasal sinuses

Aneurysmal hone cyst is rare in paranasal sinuses. It may be uni or multilocutar It occurs alone or with other benign bone lesions. The exact pathogenesis of it is still unknown. The aggressiveness of the disease needs early diagnosis and proper management to prevent recurrence. This report describes a case of aneurysmal bone cyst involving the ethmoid and maxillary sinuses which was successfully managed.     

57例鼻腔鼻窦T细胞淋巴瘤临床疗效及预后分析

目的探讨鼻腔鼻窦T细胞淋巴瘤临床疗效及预后因素。方法回顾性分析1983年7月~2001年4月我院收治的57例鼻腔鼻窦T细胞淋巴瘤,其中单纯放疗(R组)22例,放疗 化疗(R C组)35例。Kaplan-Meier法计算3,5年生存率和局控率,Logrank进行显著性检验和单因素分析,Cox模型进行多因素分析。结果放疗组(R组)和放疗 化疗组(R C组)3,5年生存率分别为64.7%,55.2%和74.4%,69.8%。两组3,5年生存率比较有统计学意义(P<0.05)。两组3,5年局控率分别为95.4%,87.2%和94.5%,89.7%。两组3,5年局控率比较无统计学意义(P>0.05)。多因素分析显示,B症状、临床分期、治疗方式和放疗剂量是影响鼻腔鼻窦T细胞淋巴瘤生存率的独立预后因素;影响鼻腔鼻窦T细胞淋巴瘤局控率的独立预后因素是累及部位、临床分期、治疗方式、放疗剂量。结论放疗 化疗组(R C组)明显提高了鼻腔鼻窦T细胞淋巴瘤3,5年生存率,但不能改善局控率。B症状、临床分期、治疗方式和放疗剂量是影响鼻腔鼻窦T细胞淋巴瘤生存率的重要因素,累及部位、临床分期、治疗方式、放疗剂量与鼻腔鼻窦T细胞淋巴瘤局控有关。     

Primary aneurysmal bone cyst of the maxillary sinus in a child: case report and review of the literature

Our case report describes a primary aneurysmal bone cyst (ABC) of the maxillary sinus in a 12-year-old girl. The young patient presented with progressive diplopia, strabismus, and rapidly growing painless swelling of the left cheek. Imaging studies showed a heterogeneous contrast enhancing mass expanding the left maxillary sinus. The lesion was completely resected endoscopically and histological examination reported it as an ABC. The patient recovered well and is free of recurrence 9 months following surgery. ABC is a benign lesion usually associated with other bone pathology (fibrous dysplasia). It may behave aggressively and invade the orbit; so resection is necessary. Minimally invasive techniques such as endoscopic sinus surgery can be performed successfully in select cases. Long follow up is important because recurrence may occur, in which case further resection is warranted.     

Submandibular approach to anterior C2-C4 disc space in the management of an aneurysmal bone cyst

We report a case of a ten-year-old girl with a large posterior neck mass, an aneurysmal bone cyst involving the upper cervical spine.Patient underwent tumor resection through a posterior approach and required subsequent anterior fusion and instrumentation of C2-C4 for stability. We describe a challenging transcervical submandibular approach that allowed anterior cervical discectomy with placement of interdisc spacer using pre-contoured allograft and plating to achieve anterior fusion. We demonstrated that this approach is safe and effective in children, and provides excellent visualization for direct access with a surprisingly large operative field for instrumentation.     

19例Rathke囊肿的诊断和显微手术治疗

目的提高Rathke囊肿的术前诊断率和探讨最佳手术方法。方法回顾分析19例经术后病理证实为Rathke囊肿的病例。主要临床表现包括头痛(63.2%),视觉缺陷(53.6%)及下丘脑-垂体功能紊乱(42.1%)。术前CT及MRI检查发现均为鞍区囊性肿物。13例采用经鼻-蝶窦入路显微外科手术,6例采用经右额底开颅手术。结果术前正确诊断垂体Rathke囊肿的9例,术后随访3个月,病人的头痛症状全部缓解,下丘脑-垂体功能紊乱62.5%得到改善,视觉缺陷80%得到改善。19例病人术后10个月均无复发。结论Rathke囊肿术前CT与MRI检查均有一定特异性,结合CT与MRI检查能提高Rathke囊肿术前诊断率。经鼻-蝶窦入路显微手术治疗是目前治疗Rathke囊肿的最佳方法。     

Aneurysmal bone cysts of the head and neck in pediatric patients: a case series

OBJECTIVES: To characterize aneurysmal bone cysts (ABCs) of the head and neck as seen at a tertiary care center. DESIGN: A case series. METHODS: A retrospective chart review of pediatric patients with aneurysmal bone cyst of the head and neck treated at the Hospital for Sick Children during the years 1994-2006 was carried out. RESULTS: Nine patients with ABC were treated. The average age at diagnosis was 9.3 years (range: 5 months-15 years), six males and three females. Four cysts originated in the paranasal sinuses, two in the mandible, one in the zygoma, one in the mastoid and one in the parietal bone. Two cases were associated with a previous localized trauma (mandible, zygoma). 5/9 presented with pain, 4/9 presented as an asymptomatic mass, 2/9 were associated with proptosis and nasal obstruction, 2/9 with nasal obstruction and 1/9 presented with an aural polyp. Seven cysts were successfully excised while one (in the pterygomaxillary fossa) is being followed conservatively. In one case the ABC was found to be secondary to an extensive osteoblastoma and this child continuous to be problematic. Follow-up time ranged from 2 years and 6 months to 10 years. CONCLUSIONS: ABC of the head and neck may vary in presentation and severity. Surgical removal is the treatment of choice at our institution and may provide a satisfying outcome. ABC may be secondary to an underlying bone pathology (e.g., osteoblastoma) which may make it refractory to treatment.     

Simple bone cyst: report of cases and proposal for a minimal surgical intervention

Simple bone cyst (SBC) is an intraosseous pseudocyst that appears as a radiolucent lesion, frequently observed among young patients. In this article we report six cases of SBC and propose a protocol for minimal surgical intervention in the management of this condition. No history of trauma was reported. All patients underwent a minimal bone intervention procedure to perforate the cortical bone and stimulate blood clot formation. Complete healing and no recurrence were observed after 1-year follow-up. This treatment shows advantages such as the establishment of a definitive diagnosis and low invasiveness, particularly in pediatric patients.     

鼻腔鼻窦软骨肉瘤9例临床分析

目的：提高对发生于鼻腔鼻窦的软骨肉瘤的诊治水平。方法：回顾性分析9例鼻腔鼻窦软骨肉瘤患者的临床资料。结果：鼻腔鼻窦软骨肉瘤的临床病理特征复杂且差别较大，4例继发性鼻腔鼻窦软骨肉瘤患者比原发性患者病变广泛且接近颅底，预后较差，不规则的斑块状钙化点是本病典型的影像学特点。9例均是经行部分或全部肿块切除后病理确诊，病理学分级以I级多见。结论：结合既往史，临床表现和CT检查，尽早手术探查行部分或全部肿块切除术有助于早期诊断和提高疗效。     

鼻内镜下重塑鼻腔结构治疗结构性鼻炎

目的探讨鼻内镜下重塑鼻腔结构治疗结构性鼻炎的可行性。方法对68例结构性鼻炎病人进行鼻内镜下选择性多结构手术治疗,随访6个月至2年,评估疗效。结果56例治愈,10例有效,2例无效,有效率97.1%(66/68)。结论鼻内镜下重塑鼻腔结构治疗结构性鼻炎是一种值得推荐的方法。