鼻内镜鼻窦手术治疗慢性鼻窦炎临床分析

［摘要］　目的　探讨鼻内镜鼻窦手术治疗慢性鼻窦炎的临床疗效。方法　对该院2009-02～2012-02行鼻内镜鼻窦手术治疗的120例慢性鼻窦炎患者的临床资料进行回顾性总结。结果　术后随访6～12个月,120例患者中治愈96例（80.0%）,显效17例（14.2%）,无效7例（5.8%）,总有效率为94.2%。结论　围手术期准备充分、手术操作精细恰当合理、坚持术后随访、加强术腔清洁处理等措施可提高手术疗效。     

鼻内窥镜手术并发症原因分析

目的分析鼻内窥镜手术并发症的发生原因,并探讨其预防措施。方法对58例发生鼻内窥镜手术并发症患者的临床资料进行回顾性分析。结果 58例中,发生脑脊液鼻漏1例,为全蝶筛窦开放术术中损伤筛窝所致;发生球后血肿2例、眶周淤血和气肿12例,其发生原因均为眶穿破;眶内炎性肿块3例,可能与纸板损伤及纱条填塞对眶内组织刺激有关;泪道损伤2例,为上颌窦开窗时损伤鼻泪管所致;鼻腔粘连24例,其主要原因为术中处理不当及术后随访处理不及时;窦口闭锁8例,为术中窦口周围组织损伤过重,窦口开放不全所致;大出血6例,为术中损伤筛前动脉或蝶腭动脉及鼻腔黏膜撕裂所致。结论鼻内窥镜手术并发症的发生原因是病变范围广泛、鼻窦解剖结构异常、手术损伤、局部麻醉及术后随访处理不及时等。适当的围手术期处理,精细的手术操作以及术后及时随访是预防该手术并发症发生的主要措施。     

鼻、鼻窦常规手术与内窥镜手术的临床疗效比较

鼻内窥镜手术的优越性在于能在狭窄的鼻腔中获得良好视野,使手术更精确,并能充分保留鼻腔结构的功能。现对我院１９９８年８月至２０００年８月间所作的９６例鼻、鼻窦手术进行分析,并比较常规术式与内窥镜手术的优缺点。１资料与方法１．１一般资料本组９６例中,男６２例,女３４例;年龄１８～７０岁,平均４８岁。常规鼻、鼻窦手术５２例,其中上颌窦根治术３３例,筛窦开放术１９例;４１例伴鼻息肉者行摘除术。内窥镜鼻、鼻窦手术４４例,共７３侧鼻腔。常规鼻、鼻窦手术术前均行前鼻镜及间接鼻咽镜检查,并作Ｘ线华柯氏位和ＣＴ扫…     

鼻内镜鼻窦手术后迟发性视力障碍12例分析

鼻内镜鼻窦手术后期发现视力障碍者较少见。2003年6月～2005年6月，我院收治12例（19眼）术后并发视力障碍者。现分析如下。     

内镜颅底外科

面对复杂多样、位置深在的颅底病变,神经外科、耳鼻喉科、头颈颌面外科的医师们一直在通过不懈努力探索更好的手术入路,不断完善手术方法。近年来,除了传统的开放显微外科入路,内镜颅底入路逐渐得到认可,被认为是颅底外科的两大发展方向之一。这种局面的出现主要得益于内镜设备的快速发展、深入人心的微侵袭手术理念和颅底解剖学及影像学的迅速发展。内镜虽小,却为医师提供了颅底不同解剖区域清晰的视野。     

120例鼻内镜下鼻窦开放患者围手术期护理体会

2003年3月～2006年3月，我科对120例患者行鼻内镜下鼻窦开放术，现将围手术期的护理体会报告如下。     

步长必畅香菊胶囊用于鼻内镜术后临床观察

近年来,我们对36例鼻息肉、慢性鼻窦炎患者行鼻内镜下鼻腔、鼻窦手术,术后配合使用步长必畅香菊胶囊治疗,取得满意疗效。现报告如下。     

鼻内镜下多种入路手术治疗上颌窦病变

目的：探讨鼻内镜下不同入路处理上颌窦病变的方法及其适应证。方法245例上颌窦病变患者,采用鼻内镜下中鼻道上颌窦开窗术、下鼻道上颌窦开窗术、犬齿窝入路上颌窦开窗术、鼻腔外侧壁切开术、鼻腔外侧壁切除术不同入路进行手术治疗。结果245例患者手术顺利,无手术并发症发生。185例慢性鼻窦炎合并上颌窦炎患者治愈144例,好转39例,无效2例;上颌窦囊肿、真菌性鼻窦炎、上颌窦内翻性乳头状瘤及乳头状瘤癌变患者均无复发。结论单纯行中鼻道上颌窦开窗术可处理绝大部分的上颌窦囊肿、上颌窦出血性坏死性息肉、累及上颌窦的真菌性上颌窦炎及慢性鼻窦炎,而对于累及上颌窦前内的病变,可适当将上颌窦开窗口向前扩大。当上颌窦发育较大,齿槽隐窝较明显时,采用中鼻道、下鼻道上颌窦开窗术联合犬齿窝入路。泪前隐窝区域病变采用鼻内镜下鼻腔外侧壁切开术。广泛侵及上颌窦及鼻腔外侧壁（如下鼻甲）的恶性肿瘤,则需要采用鼻腔外侧壁切除术。     

内镜下经鼻蝶入路手术治疗鞍区病变疗效观察

目的观察内镜下经单鼻孔蝶窦入路手术治疗鞍区病变的疗效。方法鞍区病变患者54例,均采用内镜下经单鼻孔蝶窦入路手术。其中垂体腺瘤47例,行肿瘤全切术39例、次全切除术6例、部分切除术2例;Rathke囊肿3例,均行全切除术;颅咽管瘤3例,行全切除术1例、次全切除术2例;垂体脓肿1例行病灶清除术。10例次全切除+部分切除者,术后均行放疗。结果本组无手术死亡病例。术后发生暂时性尿崩症12例、脑脊液鼻漏4例、鼻腔出血2例、颅内感染1例,经对症治疗均恢复。术后随访6～24个月,患者临床症状有不同程度改善,激素水平降至正常26例,较术前降低50.0%以上10例。术后随访无复发或瘤体增大。结论内镜下经单鼻孔蝶窦入路手术治疗鞍区病变创伤小、安全、肿瘤全切率高、并发症少、患者恢复快。     

老年人鼻内镜下鼻中隔手术192例

我科自2002年1月至2008年12月,共收治鼻中隔偏曲老年患者192例,均在鼻内镜下顺利完成手术. 1 资料与方法 1.1 对象 192例患者中,男110例,女82例,年龄60～81岁,平均67.7岁.其中60～69岁136例(71%),70～80岁48例(25%),＞80岁8例(4%).鼻中隔偏曲伴慢性鼻窦炎、鼻息肉79例,鼻中隔偏曲伴下鼻甲肥大62例.117例伴高血压,99例伴糖尿病,78例伴高血压合并糖尿病,26例伴有慢性支气管炎、肺气肿,5例患者伴有慢性支气管炎合并高血压.     

Evaluation of patient nasal saline irrigation practices following endoscopic sinus surgery

Background

Functional endoscopic sinus surgery (FESS) is an effective treatment for chronic rhinosinusitis (CRS). Postoperative management strategies after FESS often vary from surgeon to surgeon. Recent data suggests that nasal saline irrigation following FESS is almost universally recommended; however, patient adherence has not been formally evaluated. The purpose of this study is to evaluate postoperative nasal irrigation practices and its effects on short‐term outcomes in post‐FESS patients.

Methods

Eighty‐two patients were followed prospectively following FESS at a tertiary‐academic medical institution for 3 postoperative visits. Patients were surveyed on their irrigation practices (start date, frequency, and volume per irrigation per side), and adherence to prescribed antibiotic and steroid regimens. At each visit, 22‐item Sino‐Nasal Outcome Test (SNOT‐22) questionnaires and endoscopic examinations were evaluated by the Lund‐Kennedy Endoscopy Score (LKES). Factors evaluated include: patient demographics (age, sex, ethnicity), preoperative Lund‐Mackay and SNOT‐22 scores, comorbidities, extent of procedure, and use of nasal packing and/or spacers.

Results

Adherence to irrigation instructions was 82.9%. Factors significantly associated with compliance with irrigation instructions included younger age (p = 0.0022), prior irrigation (p < 0.0001), revision surgery (p = 0.0014), and non‐native English language speaking (p = 0.0095). Patients were more likely to irrigate with larger volumes if they were younger (p = 0.0284), had prior irrigation (p < 0.0001), or had revision surgery (p = 0.0056).

Conclusion

Multiple factors are associated with patient compliance with nasal saline irrigation after FESS. Ethnic and cultural considerations, such as language barriers, should also be considered to improve outcomes. Identification of patients who may be noncompliant could potentially benefit from increased preoperative counseling to improve adherence rates.     

功能性内窥镜鼻窦手术在老年患者的应用

目的 探讨功能性内窥镜鼻窦手术在老年慢性鼻窦炎、鼻息肉患者的应用及其疗效。方法 总结74例≥岁老年慢性鼻窦炎、鼻息肉患者行功能性内窥镜手术的临床资料,以同期行相同手术的199例59岁以下患者为对照组。结果 老年组与对照组手术治愈率分别为79．5％和77．9％。结论 功能性内窥镜鼻窦手术同样适合于老年患者,可望提高老年患者的生存质量。     

鼻内镜下手术治疗慢性鼻窦炎鼻息肉128例

目的 探讨鼻内镜下慢性鼻窦炎、鼻息肉的手术疗效.方法 对实施内窥镜鼻窦手术并完成术后随防6个月以上的128例患者进行病历资料分析.结果 治愈率(症状完全消失) 79.7%,好转率15.6%,无效率4.7%,总有效率95.3%.结论 鼻内镜手术治疗慢性鼻窦炎、鼻息肉有较好的效果.做中鼻甲和鼻中隔偏曲的处理和术前病情评估及加强术后的综合治疗是提高治愈率的关键.     

鼻咽癌原发灶残留或复发的鼻内镜手术治疗

鼻咽癌经过首程治疗后,原发灶仍有部分残留及复发。研究表明,有效的救援治疗手段只有放射治疗和手术治疗。但再程放疗效果差且后遗症较多。常规手术要么术野暴露不清,要么创伤大,术中出血多,术后瘢痕形成,多数患者难以接受。随着鼻内镜的广泛应用,逐渐显示其在鼻咽癌原发灶残留或复发手术中的优势。该文通过观察鼻内镜手术切除残留或复发病灶与再程放疗患者生存率及生存质量的对比,阐述了鼻内镜手术在鼻咽癌原发灶残留或复发中应用的可行性。     

功能性鼻内镜鼻窦手术治疗老年慢性鼻-鼻窦炎鼻息肉的安全性评估

目的探讨老年慢性鼻-鼻窦炎鼻息肉患者行功能性鼻内镜鼻窦手术（functional endoscopic sinus surgery,FESS）的安全性。方法回顾性对照性研究,分析中山大学附属第一医院耳鼻咽喉科医院2007年8月至2010年4月拟行FESS手术的老年患者（≥60岁）101名的病例资料,并随机抽取同期行FESS手术的中青年患者（18～59岁）100例作为对照组,比较合并疾病、手术出血量、手术时间和手术并发症的差异,围手术期合并疾病情况。结果101名老年患者中60％合并基础疾病,高于中青年组（19％,P〈0．05）,老年组5例经术前评估不能耐受手术,其余96名行FESS手术,手术时间（50minVS60min）、手术出血量（50mLVS50mL）和并发症发生率（1％VS2％）两组间差异无统计学意义（P〉0．05）。并发症：老年组1例,为术后需要输血,中青年组2例,均为纸样板损伤。所有病例围手术期基础疾病无恶化。结论经过仔细的术前评估处理,老年慢性鼻-鼻窦炎鼻息肉行FESS手术的安全性良好。     

Dexmedetomidine-soaked nasal packing can reduce pain and improve sleep quality after nasal endoscopic surgery: a double-blind,randomized, controlled clinical trial

Study objective

Bilateral endoscopic nasal surgery is usually associated with pain and sleep disturbance. The aim of this study was to evaluate the effects of dexmedetomidine-soaked nasal packing on analgesia and improvement of sleep quality in patients undergoing this surgery.

Method

Eighty patients were enrolled and randomly allocated into 4 groups. At the end of surgery, dexmedetomidine-soaked nasal packings were applied to three groups with a dosage of 1 μg kg^?1 (D1), 2μg kg^?1 (D2), 4 μg kg^?1 (D4) and normal saline-soaked nasal packing (NS) was applied to a fourth group. The primary outcome was postoperative pain scores using a visual analog scale (VAS) recorded at six time points: before the surgery (T1); 2 h (T2), 8 h (T3), 24 h (T4), 48 h (T5) after surgery; and at the moment of nasal packing removal (T6). Secondary outcomes were postoperative sleep status evaluated by the Pittsburgh sleep quality index (PSQI) and subjective sleep quality value (SSQV). Factors affecting sleep, hemodynamic changes, and adverse events were also recorded.

Results

Compared with the NS group, dexmedetomidine-soaked nasal packing significantly relieved postoperative pain and improved sleep quality. The effect was similar between D2 and D4, which was greater than in D1. However, D2 was associated with fewer adverse events.

Conclusions

Dexmedetomidine-soaked nasal packing not only offers effective analgesia but also improves postoperative sleep quality in patients undergoing bilateral endoscopic nasal surgery. Taking effect and adverse events into consideration, a dosage of 2μg kg^?1 may be optimal.

Trial registration

www.chictr.org.cn/index.aspx (ChiCTR1900025692) Retrospectively registered 5 September 2019

     

Evolving endoscopic surgery

Since the days of Albukasim in medieval Spain, natural orifices have been regarded not only as a rather repugnant source of bodily odors, fluids and excreta, but also as a convenient invitation to explore and treat the inner passages of the organism. However, surgical ingenuity needed to be matched by appropriate tools and devices. Lack of technologically advanced instrumentation was a strong deterrent during almost a millennium until recent decades when a quantum jump materialized. Endoscopic surgery is currently a vibrant and growing subspecialty, which successfully handles millions of patients every year. Additional opportunities lie ahead which might benefit millions more, however, requiring even more sophisticated apparatuses, particularly in the field of robotics, artificial intelligence, and tissue repair (surgical suturing). This is a particularly exciting and worthwhile challenge, namely of larger and safer endoscopic interventions, followed by seamless and scarless recovery. In synthesis, the future is widely open for those who use together intelligence and creativity to develop new prototypes, new accessories and new techniques. Yet there are many challenges in the path of endoscopic surgery. In this new era of robotic endoscopy, one will likely need a virtual simulator to train and assess the performance of younger doctors. More evidence will be essential in multiple evolving fields, particularly to elucidate whether more ambitious and complex pathways, such as intrathoracic and intraperitoneal surgery via natural orifice transluminal endoscopic surgery (NOTES), are superior or not to conventional techniques.