全国鼻内镜鼻一鼻窦微创手术及其延伸的理论和技术学习班

由中山大学附属第三医院、中山大学耳鼻咽喉科学研究所主办，南昌大学第二附属医院协办的国家级继续教育项目《全国鼻内镜鼻一鼻窦微创手术及其延伸的理论和技术学习班》拟定于2006年4月27N30日在江西省吉安市井岗山举行。学习班内容包括：鼻、鼻窦及相关疾病治疗策略的新理念：经鼻内镜鼻一鼻窦手术解剖基础与手术技巧：手术风险预测与并发症处理对策：鼻眼相关手术与鼻颅底相关手术新进展等。     

影响慢性鼻-鼻窦炎手术预后的相关因素分析

目的：探讨影响慢性鼻-鼻窦炎手术预后的相关因素。方法：回顾性分析210例经鼻内镜手术的慢性鼻-鼻窦炎患者的临床资料,通过Logistic回归模型分析影响慢性鼻-鼻窦炎患者手术预后的诸因素。结果：相关因素分析表明,患者年龄、长期应用鼻减充血剂、鼻窦手术复发、变应性鼻炎病史、鼻内镜术后的综合治疗是影响慢性鼻-鼻窦炎手术预后的独立因素。结论：评估慢性鼻-鼻窦炎手术预后的重要依据是患者年龄、是否长期应用鼻减充血剂、是否伴有变应性鼻炎病史、是否慢性鼻窦炎手术复发患者、是否坚持鼻内镜术后的综合治疗。要强调鼻内镜术后的综合治疗包括鼻内糖皮质激素的应用、术后随访和鼻腔清理、黏液稀化剂和抗生素的应用,可提高鼻内镜手术的治愈率。     

鼻颅底外科颅底重建的策略与技巧

颅底重建是经鼻内镜颅底手术最重要的技术环节之一, 直接影响手术的成败和患者的预后。在过去10年中, 得益于鼻内镜技术、手术设备与器械、内镜颅底解剖学、内镜颅底外科理念等多方面的进步, 内镜颅底重建技术也得到了快速发展。本文就鼻颅底外科手术中不同类型颅底缺损的特点、修复重建原则与方法、术后管理等方面进行阐述与总结, 以期加强该领域学者之间的交流和对相关理论体系的再认识。     

鼻内镜外科技术的临床应用

目的 探讨鼻内镜外科技术的临床应用。方法 综述近5年鼻内镜外科手术的临床应用进展和外延的相关文献。结果 鼻内镜已广泛应用于鼻腔鼻窦病变的临床研究、辅助诊断、临床治疗及术后随访中。结论 鼻内镜在鼻腔鼻窦手术、颅底外科手术、鼻眼相关科学、整容及面骨重建手术中体现出独特的优越性。     

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全国鼻内镜鼻-鼻窦微创手术及其延伸的理论和技术学习班由中山大学附属第三医院、中山大学耳鼻咽喉科学研究所主办,南昌大学第二附属医院协办的国家级继续教育项目《全国鼻内镜鼻-鼻窦微创手术及其延伸的理论和技术学习班》拟定于2006年4月27～30日在江西省吉安市井岗山举行。学习班内容包括:鼻、鼻窦及相关疾病治疗策略的新理念;经鼻内镜鼻-鼻窦手术解剖基础与手术技巧;手术风险预测与并发症处理对策;鼻眼相关手术与鼻颅底相关手术新进展等。授课方式:多媒体专题讲座;新鲜尸头手术示教与解析;经典鼻内镜手术录像等。授予国家级继续教育学分…     

我国鼻内镜外科技术的发展现状

我国开展鼻内镜手术的临床研究工作至今已逾10年，鼻外科学得到了快速发展。在参照国外发达国家先进技术的同时，结合我国医疗卫生条件的实际情况、疾病特征及实践经验，总结我国鼻内镜外科技术的研究工作，主要表现在以下几个方面：①以鼻内镜手术技术为核心，建立对慢性鼻一鼻窦炎规范化综合治疗的理念；②逐步建立了儿童慢性鼻一鼻窦炎阶梯性治疗的概念；③探索了经鼻内镜鼻眶一鼻颅底微创手术的适应证及相关解剖学的研究；④采用鼻内镜手术配合放射和化学治疗鼻一鼻窦恶性肿瘤等。上述内容表明，我国鼻内镜外科学技术体系正在逐步走向成熟。     

鼻内镜手术的眶并发症

随着鼻内镜手术技术的普及和提高,鼻内镜手术设备的不断更新,鼻内镜鼻窦手术的开展越来越广泛和深入,极大地提高了鼻腔、鼻窦疾病的手术治疗效果,拓宽了经鼻手术的适应证,但是,由此而引起的并发症跟传统手术比较却没有减少。本文拟就由经鼻内镜鼻窦手术引起的眶并发症作一综述。     

鼻内镜手术的眶并发症

随着鼻内镜手术技术的普及和提高,鼻内镜手术设备的不断更新,鼻内镜鼻窦手术的开展越来越广泛和深入,极大地提高了鼻腔、鼻窦疾病的手术治疗效果,拓宽了经鼻手术的适应证,但是,由此而引起的并发症跟传统手术比较却没有减少。本文拟就由经鼻内镜鼻窦手术引起的眶并发症作一综述。     

影像导航技术在鼻窦-颅底内镜手术中的应用

随着影响导航技术的发展和不断应用,鼻内镜下鼻窦、鼻颅底和鼻眼相关等手术取得了进一步发展,鼻内镜手术操作更加精准,安全性更高。本文从影像导航技术的工作原理及其在鼻窦-颅底外科领域的应用历史、适用范围和应用态度进行了系统论述,并对影像导航技术在鼻窦-颅底外科领域的临床应用进展和未来发展方向进行了说明。     

第4届鼻内镜解剖和手术技术培训班

由首都医科大学附属北京友谊医院主办的第4届鼻内镜解剖和手术技术培训班（No：国20140701031）定于2014年6月27-29日在北京召开。培训班将邀请国内著名鼻科学专家莅临授课,与学员分享多年的临床积累及学科新进展。学习班内容包括鼻腔鼻窦解剖和鼻内镜微创手术的难点与风险、鼻腔鼻窦恶性肿瘤的手术治疗、鼻颅底相关疾病的诊治特点、鼻-眼相关疾病的诊治等。     

Virtual reality surgical planning for endoscopic endonasal approaches to the craniovertebral junction

PurposeTo demonstrate the utility of virtual reality (VR) for preoperative surgical planning of endoscopic endonasal craniovertebral junction (CVJ) surgery.Materials and methodsFive patients who had undergone endoscopic endonasal surgery of the craniovertebral junction with preoperative virtual reality surgical planning were identified and described.ResultsThe anterior approach to the CVJ has been traditionally accomplished transorally. However, recently the transnasal endoscopic approach to this location has been described. Multiple anatomical studies have been conducted using the nasopalatine, nasoaxial, and rhinopalatine lines (NPL, NAxL, RPL) in an attempt to preoperatively delineate the inferior limits of endoscopic dissection. The use of advanced surgical simulation using immersive virtual reality is an innovative approach for analyzing CVJ anatomy and developing a surgical plan. VR simulation through the use of interactive and highly accurate patient specific models allows for the creation of three-dimensional (3D) digital reconstructions via the fusion of CT and MRI studies. Incorporation of simulation technology has been shown to increase surgeon proficiency while simultaneously decreasing complication rates. The described case series demonstrates the novel utility of VR planning for designing the endoscopic surgical approach to the CVJ.ConclusionsVR technology allows for the creation of anatomically accurate 3D models that can be used for preoperative planning of endoscopic endonasal surgery. Such models help in the development of safe surgical plans by predicting inferior and lateral planes of dissection and assisting in the identification of critical structures.     

内镜鼻颅底外科在神经外科发展中的现状和展望

 颅底外科手术难度大,风险高。内镜鼻颅底外科技术不断进步,手术领域日益拓展,发展前景令人瞩目。目前限制内镜鼻颅底外科在神经外科发展的主要因素是神经外科术者鼻颅底内镜学习曲线较长,术后脑脊液漏和颅神经功能损害等手术并发症。因此,加强内镜操作训练,熟悉鼻颅底内镜解剖,重视颅底重建和术中神经电生理监测,减少术后脑脊液漏和颅神经功能损害发生率,强调多学科合作治疗颅底肿瘤都是进一步安全有效发展内镜鼻颅底外科的重要措施。     

Invertierte Papillome der Nase und ihrer Nebenhöhlen Langzeitergebnisse nach endoskopischer endonasaler Resektion

There is still some skepticism about endoscopic endonasal resection of inverted papillomas. We conducted a long-term retrospective study and examined 104 patients (82 male, 22 female) with inverted papilloma who were operated at the ENT-Department of the University of Erlangen between 1974 and 1997. The endoscopic approach was chosen in each case, either alone or in combination with external approaches. In 64.4% (67 cases), tumors of all T-classes were resected by endoscopic approach alone (T1:17.9%, T2:23.9%, T3:41.8%, T4:16.4%). For the rest of the patients an additional transoral and transfacial approach was necessary due to difficult tumor localization (T2:24.3%, T3:29.7%, T4:45.9%). The mean age of the patients was 55 years. The recurrence rate after primary endoscopic endonasal sinus surgery was 22.4% (15/67) and after combined endoscopic and external surgery 16.2% (6/37). Second salvage surgery after endoscopic sinus surgery was performed again endonasally in 46% (7/15) and externally in 53.3% (8/15). The recurrence rate after the endonasal approach was now 57.1% (4/7) and 50% (4/8) after external surgery. Third salvage surgery was performed again endoscopically in four cases and externally in four cases. The recurrence rate in both groups was 50% each, so that up to six operations, either endoscopically or externally, were necessary for complete tumor resection. The longest period for a tumor recurrence was 3.4 years after endoscopic sinus surgery and 9 years after combined endoscopic and external surgery. A tumor recurrence after endoscopic endonasal sinus surgery that could not be managed endoscopically again occurred in 12%. Tumor localization is the limiting factor for endoscopic endonasal sinus surgery of inverted papilloma. However, in 64.4% of cases, endoscopic endonasal sinus surgery alone was performed successfully without any loss of one patient. Long-term follow-up is necessary since the recurrence of tumor can happen after a long time. Endoscopic endonasal sinus surgery of inverted papilloma is safe and should be preferred due to its minimal invasive character.     

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.     

内镜下经咽隐窝入路岩尖胆固醇肉芽肿的外科治疗并文献复习

目的探讨经咽隐窝入路治疗岩尖胆固醇肉芽肿的可行性。方法报道一例左侧颞骨岩尖胆固醇肉芽肿患者经咽隐窝入路治疗的方法,并回顾文献报道的手术方法的优缺点。结果该例患者术后听力恢复,耳闷、耳鸣症状消失,无任何并发症。随访10月无复发。结论经咽隐窝入路手术是治疗胆固醇肉芽肿可供选择的一种新方法,可简单迅速直达病变,降低了手术风险,减少了手术创伤。     

No thermal tool using methods in endoscopic dacryocystorhinostomy: no cautery, no drill, no illuminator, no more tears

The purpose of this study was to evaluate the surgical outcome of the endoscopic dacryocystorhinostomy (DCR) without thermal tools such as cautery, drill and illuminator. The study is a retrospective analysis of patients in a tertiary care unit for oculoplastic surgery. The participants enrolled into the study are a retrospective series of 127 consecutive endonasal DCRs performed between January 2008 and March 2011. The surgical procedure in this conventional endoscopic transnasal DCR involved a manual osteotomy of the frontal process of the maxilla and removal of the lacrimal bone by punch without illuminator, cauterization and drill. We evaluated the result of the manual Endo-DCR technique without cauterization or drilling-assisted technique. Data of 127 eyes were reviewed. Full success was achieved in 90.5 % (115/127) of manual Endo-DCR technique with an average follow-up period of 6 months. Our study appears to show favorable results compared to other previously published outcomes including Endo-DCR surgery with thermal equipments. No thermal tool methods in endonasal DCR can achieve a good surgical success rate. Therefore, the newest tools, cauterization, drilling or illumination, are generally not necessary for endoscopic dacrycystorhinostomy.     

Acquisition of surgical skills for endonasal skull base surgery: a training program

Introduction : Endonasal surgery represents a radical change in the practice of cranial base surgery and requires the acquisition of new knowledge and surgical skills. The optimal training program for surgeons has not been established. Methods : We reviewed our experience with endonasal cranial base surgery from 1998 to 2006 to develop a training plan for the acquisition of surgical skills. It consists of a modular and incremental approach to endonasal skull base surgery that is designed to train surgeons to function as a team, learn endoscopic skull base anatomy, and develop fundamental endoscopic skills. Results : Stages of training are established for the otolaryngologist–head and neck surgeon and the neurosurgeon that are based on level of technical difficulty, potential risk of vascular and neural injury, and unfamiliar endoscopic anatomy. Mastery of each level is recommended before attempting procedures at a higher level. Conclusions : Standardization of training and the adoption of a modular, incremental training program are expected to facilitate the training of endonasal surgeons in both surgical specialties. Adherence to such a program during the growth phase of endoscopic skull base surgery may decrease the risk of complications as the surgeon's knowledge and surgical expertise develop.     

The overview of the surgical methods for the treatment of endocrine ophthalmopathy

To analyse the efficacy of various surgical methods for the treatment of endocrine ophthalmopathy and to estimate the potential of endonasal endoscopic surgery for the management of this pathology. The available literature publications concerning surgical treatment of endocrine ophthalmopathy were reviewed; their data were compared with the results of endoscopic endonasal surgery performed by the authors. Various surgical techniques including those with the use of external and endonasal transethmoidal approachers are discussed with special emphasis on the resection of the medial and inferior orbital walls. The analysis of surgical techniques, peculiarities of postoperative treatment, and its outcomes is presented. This study has demonstrated the advantages of endonasal endoscopic transethmoidal decompression of the orbit over the external surgical approach used to manage endocrine ophthalmopathy.     

Applications of Co2 laser in endoscopic surgery for sinonasal neoplasms

ObjectiveThe aim of the study is to assess safety, effectiveness, and potential advantages of CO? fiber laser during endoscopic endonasal surgery for the resection of sinonasal neoplasms.We present text, images, and videos to show our experience with this new device recently introduced in endoscopic endonasal surgery and as a potential tool for educational purpose.MethodsSix patients affected by benign or malignant sinonasal tumors who underwent endoscopic resection between January and May 2021 were enrolled in the study.Surgical approach was conducted via standardized centripetal endonasal technique.During the surgery we evaluated instrument ergonomics, quality in section on both healthy tissue and tumor, coagulation, and bleeding control from major vessels.ResultsIn our experience, CO? fiber laser has proved to have good ergonomics, as well as to be a safe and effective tool for the resection of both neoplastic and healthy tissues. Cauterization was efficient only in vessels with average diameter lower than 1 cm.Prolonged procedural time, costs, and necessity of learning-curve and expertise are possible drawbacks.ConclusionCo2-fiber laser is an effective tool which can aid the surgeon during endoscopic endonasal approach to sinonasal neoplasms.     

Mini-endoscopy of the frontal sinus to guide endonasal frontal sinus surgery

Endoscopic frontal sinus surgery requires special attention to the numerous anatomical variations. Additionally, in situations of revision surgery, endonasal frontal sinus identification may be challenging. Numerous strategies have been described to access the frontal sinus in endonasal endoscopic frontal sinus surgery including an additional external approach. A pilot study is presented using a newly designed modular mini-endoscope (1.1 mm, 10.000 pixel, 2 working channels and 120° lens) to assist the frontal sinus surgery through a transcutaneous puncture of the frontal sinus. We used this mini-endoscope for primary frontal sinus surgery on 3 patients and for revision frontal sinus surgery on 4 patients. In all patients, the mini-endoscope could be placed in the frontal sinus without side effects. The visible illumination at the frontal sinus floor, caused by the mini-endoscope being in the frontal sinus, guided the surgeon endonasally directly to the frontal sinus floor. Frontal sinus drainage was achieved by the described guidance on all patients. In conclusion, mini-endoscopy of the frontal sinus might be an interesting option in endoscopic frontal sinus surgery to guide the surgeon by illumination in complex anatomical situations to the frontal sinus. This technique will contribute to further improvement in endonasal endoscopic frontal sinus surgery.