鼻内镜下鼻腔内翻性乳头状瘤电凝电刀手术治疗后初步观察

目的：探讨鼻内窥镜下电凝电刀手术治疗鼻腔内翻性乳头状瘤的方法和初步疗效。方法：对2008年11月至2010年12月诊治的20例鼻腔内翻性乳头状瘤的临床资料进行回顾性分析,全部患者均接受鼻内窥镜下鼻腔乳头状瘤切除术的手术方案。按Krouse分级,其中1级局限于鼻中隔患者3例和2级病变位于鼻腔上颌窦口周围患者10例,病变侵及筛窦5例,均全程采用电凝电刀完成手术治疗,属3级病变的既往手术复发者2例,病变累及全组鼻窦伴轻度骨质破环2例,采用电刀电凝结合电动吸切器完成手术治疗,手术过程均在全麻鼻内窥镜下进行。结果：除2例复发的属3级病变的鼻腔乳头状瘤病例,均完成肿瘤根治切除,术中出血较少,除2例复发性内翻性乳头状瘤患者出血约150ml外,其余18例原发性患者出血量为10-50ml,中位数出血量35ml。手术时间短,为20-60min,术中术野清晰,无颅-额-眶手术并发症,术后1天抽取纱条,3天后出院,3个月后复查见术腔完全上皮化。随访3-6个月,中位随访时间4个月,20例鼻腔乳头状瘤病例术前鼻塞,血性脓涕,头痛等症状均缓解,无复发病例。结论：电凝电刀手术治疗鼻腔内翻性乳头状瘤具有手术损伤小,手术时间短,手术视野清晰,对病变的基底及安全边缘切除彻底,不易造成瘤组织的血行播散,术中及术后出血少,围手术期不良反应轻,术后不易复发等优点,对于1级和2级病变可做到肿瘤完整切除,是一种较好的微创治疗鼻腔内翻性乳头状瘤的方法。     

内窥镜下鼻腔鼻窦内翻性乳头状瘤切除术

目的　研究微创下手术切除鼻腔鼻窦内翻性乳头状瘤的治疗效果。方法　对 2 5例鼻腔鼻窦内翻性乳头状瘤的患者施行鼻内窥镜下手术 ,术中配合使用电动吸切器切除肿瘤 ,术后随访 12～ 60个月。结果　全部 2 5例均在鼻内窥镜下一次完整切除肿瘤 ,2 5例中 2例分别于术后 12个月和 16个月内复发 ,其余 2 3例在随访期内未见复发。结论　使用鼻内窥镜微创下行鼻腔鼻窦内翻性乳头状瘤切除不仅对病变局限者有效 ,对病变广泛侵犯后组筛窦和蝶窦者亦有较好疗效。但对瘤体广泛浸及上颌窦或额窦者宜采用联合径路实施手术。     

内窥镜下鼻腔鼻窦内翻性乳头状瘤切除术

目的 研究微创下手术切除鼻腔鼻窦内翻性乳头状瘤的治疗效果。方法 对25例鼻腔鼻窦内翻性乳头状瘤的患者施行鼻内窥镜下手术，术中配合使用电动吸切器切除肿瘤，术后随访12～60个月。结果 全部25例均在鼻内窥镜下一次完整切除肿瘤。25例中2例分别于术后12个月和16个月内复发，其余23例在随访期内未见复发。结论 使用鼻内窥镜微创下行鼻腔鼻窦内翻性乳头状瘤切除不仅对病变局限者有效，对病变广泛侵犯后组筛窦和蝶窦者亦有较好疗效。但对瘤体广泛浸及上颌窦或额窦者宜采用联合径路实施手术。     

复发性鼻腔鼻窦内翻性乳头状瘤治疗分析

目的　探讨复发性鼻腔鼻窦内翻性乳头状瘤治疗。方法　对 2 6例鼻腔鼻窦内翻性乳头状瘤术后复发病人 ,行鼻外进路加经鼻内窥镜手术切除 ,术后平阳霉素术腔贴敷方法治疗。结果　 2 6例病人 ,术后随访 1～ 3年 ,痊愈 2 4例 ,复发 2例 ,治愈率 92 3%。结论　采用鼻外进路加鼻内窥镜手术的方法和药物的综合疗法 ,对复发性鼻腔鼻窦内翻性乳头状瘤治疗有重要意义     

复发性鼻腔鼻窦内翻性乳头状瘤治疗分析

目的 探讨复发性鼻腔鼻窦内翻性乳头状瘤治疗。方法 对26例鼻腔鼻窦内翻性乳头状瘤术后复发病人，行鼻外进路加经鼻内窥镜手术切除，术后平阳霉素术腔贴敷方法治疗。结果 26例病人，术后随访－3年，痊愈24例，复发2例，治愈率92．3％。结论 采用鼻外进路加鼻内窥镜手术的方法和药物的综合疗法，对复发性鼻腔鼻窦内翻性乳状瘤治疗有重要意义。     

鼻内镜下鼻内翻性乳头状瘤切除术28例临床总结与研究

目的：通过总结28例经鼻内镜下手术治疗的鼻腔鼻窦内翻性乳头状瘤临床经验，探讨不同分期的鼻腔、鼻窦内翻性乳头状瘤鼻内镜下手术治疗的优选方法以及预防复发经验。方法: 回顾性分析28例2015年1月-2017年1月我院住院的临床及病理诊断为鼻腔鼻窦内翻性乳头状瘤的患者，其中采用单纯鼻内镜下经鼻腔、鼻窦肿瘤切除术22例，鼻内镜联合泪前隐窝入路4例，鼻内镜联合眉弓入路（Lynch切口）1例，鼻内镜联合上颌窦前壁进路（Caldwell-luc）1例。结果：28例患者痊愈20例，复发8例，复发患者中T2期7例，T3期1例，复发率29%。结论：鼻腔鼻窦内翻性乳头状瘤需根据分期及不同病变部位选择不同手术方法，T1期、T2期患者可单纯鼻内镜下完成彻底切除，必要时联合泪前隐窝入路；T3期患者，病变位于额窦可鼻内镜联合眉弓进路手术（Lynch切口）或DrafⅡb、DrafⅢ型[1]，病变位于上颌窦可鼻内镜联合泪前隐窝入路或鼻内镜联合Caldwell-luc术式，T1、T2期患者疗效优于T3期患者。术后需长期随访观察，若有复发需尽早切除并电凝或等离子行病变处局部治疗。     

鼻内镜下鼻腔鼻窦内翻性乳头状瘤切除术

目的探讨经鼻内窥镜鼻腔鼻窦内翻性乳头状瘤切除术和鼻内镜联合鼻侧切开鼻腔鼻窦内翻性乳头状瘤切除术的疗效。方法26例鼻腔鼻窦内翻性乳头状瘤病例中,22例行经鼻内窥镜鼻腔鼻窦内翻性乳头状瘤切除术,4例行鼻内镜联合鼻侧切开鼻腔鼻窦内翻性乳头状瘤切除术。结果术后随访9~60个月。1例术后30个月复发,其它25例未见复发,全部病例无并发症发生。结论经鼻内窥镜鼻腔鼻窦内翻性乳头状瘤切除术适用于较局限的病变,而对广泛病变则应采用鼻内镜联合鼻侧切开术,术后鼻内镜定期复查可早期发现肿瘤复发并处理。     

鼻内镜下鼻腔鼻窦内翻性乳头状瘤切除术

目的探讨经鼻内窥镜鼻腔鼻窦内翻性乳头状瘤切除术和鼻内镜联合鼻侧切开鼻腔鼻窦内翻性乳头状瘤切除术的疗效。方法26例鼻腔鼻窦内翻性乳头状瘤病例中，22例行经鼻内窥镜鼻腔鼻窦内翻性乳头状瘤切除术，4例行鼻内镜联合鼻侧切开鼻腔鼻窦内翻性乳头状瘤切除术。结果术后随访9～60个月。1例术后30个月复发，其它25例未见复发，全部病例无并发症发生。结论经鼻内窥镜鼻腔鼻窦内翻性乳头状瘤切除术适用于较局限的病变，而对广泛病变则应采用鼻内镜联合鼻侧切开术，术后鼻内镜定期复查可早期发现肿瘤复发并处理。     

鼻内窥镜在鼻腔鼻窦内翻性乳头状瘤切除术中的应用

目的　探讨和完善鼻内窥镜下彻底切除鼻内翻性乳头状瘤 ,降低术后复发率的手术方法及其适应证。方法　 1993年 2月至2 0 0 2年 6月住院的临床及病理诊断为鼻内翻性乳头状瘤 48例 ,其中 3 0例有 1～ 4次前期经鼻或鼻侧切开手术史。 3 7例患者采用鼻内窥镜经鼻肿瘤切除术 ;11例患者肿瘤侵及中鼻道、上颌窦口和部分或全部筛窦外 ,同时广泛侵及上颌窦内采用鼻内窥镜经鼻肿瘤切除 ,同时在内窥镜下经上颌窦前壁或下鼻道开窗联合径路肿瘤切除术 ,全部病例随访 10～ 3 6个月。结果　 48例中 1例术后复发 ,47例未复发 ,治愈率 97.9%。 8例 ( 16.7% )术后换药期间发现术腔局部出现瘤样组织 ,病理证实为内翻性乳头状瘤 ,内窥镜下以YAG激光处理局部创面 ,随诊 18个月 ,未再发现有瘤样组织。结论　辅以YAG激光治疗的内窥镜经鼻内翻性乳头状瘤切除术 ,有利于彻底切除肿瘤 ,该术式避免了面部疤痕 ,但对肿瘤已广泛侵及上颌窦内者宜采用联合径路术。     

6例孤立性蝶窦肿瘤的诊断与手术治疗

目的：研究孤立性蝶窦肿瘤的诊断和治疗。方法：6例孤立性蝶窦肿瘤,全部病人均有头痛症状,其中5例有眼-神经症状,所有病人均经CT证实为孤立性蝶窦占位性病变,并在鼻内窥镜下取病检。其中良性2例,包括乳头腺瘤1例,内翻性乳头状瘤1例。恶性肿瘤4例,包括蝶窦低分化鳞癌2例,腺样囊性癌1例,内翻性乳头状瘤恶变1例。1例乳头状腺瘤行鼻内窥镜下蝶窦开放术,其余5例经鼻外筛窦径路手术。结果：2例良性肿瘤中,1例乳头状瘤治愈随访40月,1例内翻性乳头状瘤手术后随访15月症状改善。4例恶性肿瘤中3例术后放疗观察18-28月无复发。1例失访。结论：鼻内窥镜、影像学检查对本病的诊断起重要作用,并对手术有指导意义。良性肿瘤以鼻内窥镜手术为主。恶性肿瘤以手术加放疗治疗,鼻外筛窦径路是治疗此类恶性肿瘤的优选术式。     

Changes in Acoustic Parameters of Voice After Endoscopic Sinus Surgery in Patients with Nasal Polyposis

Our aim was to evaluate acoustic voice analysis of patients diagnosed with nasal polyps before and after endoscopic sinus surgery. Forty-three patients diagnosed with nasal polyposis who had undergone endoscopic sinus surgery were included in this prospective study. Patients were divided into three groups according to the stage of nasal obstruction before the surgery. Acoustic voice analyses were performed on each patient before the endoscopic sinus surgery and six weeks following the surgery with the multi-dimensional voice program. Jitter, shimmer, F₀ frequency, and noise to harmonic ratio (NHR) parameters were obtained for acoustic analysis. Our investigation showed that Jitter, shimmer and NHR values decreased, and F₀ value increased in the postoperative period in patients that had a partial nasal obstruction before the surgery. Non-significant increases were also observed in these four parameters after the surgery in cases with total or near-total nasal obstruction. We also found that the postoperative changes in shimmer values between the Stage III patients and the patients in other stages were statistically significant (P = 0.027). Voice changes that became more marked with increasing stages of the nasal polyposis. According to our results, patients should be informed of the possible alterations in speech following major surgical interventions on the paranasal sinuses.     

Long-term results of FESS — a random survey

Very little work has been published in literature about the long-term results of endoscopic sinus surgery especially with substantial numbers. A cross-sectional study was performed of patient satisfaction following endoscopic sinus surgery over a mean period of 9.8 years, of 155 patients. A variety of nasal symptoms were assessed and interesting data was recorded in relation to abatement of symptoms related to nasal and systemic allergy. Overall 94% of patients were satisfied with functional endoscopic sinus surgery (FESS) in relieving various nasal symptoms and a statistically significant number showed improvement in allergic symptoms. Our series has the longest follow-up with the largest patient group recorded in literature.     

Endoscopic Transseptal Approach to Frontal Sinus Disease

This paper describes an endoscopic transseptal approach to identify and access the frontal sinus and reviews the clinical cases. Between May 2004 and July 2010, endoscopic modified Lothrop procedure (EMLP) with transseptal approach was performed on sixteen patients. The indications for EMLP were complicated frontal sinusitis or cyst, revision surgery for failed frontal sinusotomy or Lynch procedure, or trauma cases. The first step of this procedure was to open a window in the bilateral anterior portion of the middle turbinates and nasal septum. The nasal septum, which could be observed through the window, should be the landmark of the midline during the surgery. A drill bur was raised up just behind the nasal bone along the midline of the nose. After the bilateral frontal sinuses and their posterior walls were confirmed, the interfrontal septum was removed superiorly. We reviewed the clinical records of patients who underwent the EMLP with transseptal approach. We have managed sixteen patients in this fashion. Neither intracranial nor orbital complications were encountered during or after surgery. Endoscopic transseptal frontal sinus surgery is simple to perform, and does not cause severe complications.     

Looking after local nasal and sinus mucosa in health, disease and after surgery

The paper emphasises the need for looking after of nasal and sinus mucosa in health, disease and after nasal surgery. It is a systematic arrangement of steps required to restore nasal mucosa to healthy state. These steps have been arranged to co relate them to diseases and symptoms for symptomatic and curative treatment. It can rationalise the need for surgery in cases non responsive to maximum medical treatment. It can improve postoperative surgical results after functional endoscopic sinus surgery (FESS) and other endoscopic assisted procedures.     

Medical education

Although much has been written about the surgical technique of functional endoscopic sinus surgery, for sinusitis and nasal polyposes, the other uses of the nasal endoscope has not been mentioned, Seven hundred and twenty five patients have undergone endoscopic nasal office evaluations and subsequent functional endoscopic sinus surgery for various indications in our unit from December 1990 to September 1994. Though most of the surgeries were for nasal polyposes and sinusitis, we have used the scope for various other indications.     

Endoscopic Sinus Surgery in Chronic Rhinosinusitis and Nasal Polyposis: A Comparative Study

Nasal polyposis are common presentations in patients of chronic rhinosinusitis and are considered to be associated with more severe forms of disease with poor treatment outcome. The presentation and treatment outcome after endoscopic sinus surgery in patients of chronic rhinosinusitis and nasal polyposis have been analysed in this study. A prospective analysis of 90 patients of chronic rhinosinusitis who were classified into two groups depending on presence and absence of nasal polyps was performed in the study. The two groups were evaluated using subjective (patient complaints) and objective (computed tomography scan and endoscopy scores) criteria. Preoperative data were compared with data obtained 12 months post endoscopic sinus surgery. The study included 38 patients of chronic rhinosinusitis and 52 patients of nasal polyps. The patients of nasal polyp group presented with increased severity of symptoms of nasal blockage, nasal discharge and reduced sense of smell as compared to the chronic rhinosinusitis group who had significantly higher presentation of headache and facial pain. The preoperative CT scan revealed significantly higher bilateral disease with increased involvement of multiple sinuses in nasal polyp group. Post endoscopic sinus surgery both the groups showed significant improvement in their symptoms with the nasal polyp group demonstrating reduction in improvement on 1 year follow up. In our study we have found the patients with chronic rhinosinusitis and nasal polyp have varied severity of symptoms with the nasal polyp group having higher nasal symptoms and increased severity as compared to chronic rhinosinusitis group. Though the universal rationale of management by adequate drainage and ventilation of sinus is similar in both groups, there is a reduction in both objective and subjective scores during 1 year follow up in the nasal polyp group.     

Endoscopic Approach to Middle Turbinate Squeeze Syndrome

Middle turbinate squeeze syndrome (MTSS) refers to sino-nasal headache due to intense contact between the middle turbinate and the nasal septum and/or between middle turbinate and other structures in the lateral nasal wall. This study was intended to evaluate the efficacy of precise endoscopic surgical treatment of MTSS. This is a prospective study of 126 patients with refractory cephalgia due to endoscopically confirmed MTSS who underwent functional endoscopic naso-sinus surgery (FENS) wherein the contact points and ostio-meatal complex obstruction were endoscopically relieved. 91% of cases reported improvement/resolution of headache and 95% of cases had relieved contact points as documented endoscopically. This surgery was also found to facilitate resolution of sinus disease, both radiologically (in 64% of cases) and endoscopically (in 94% of cases). Cephalgia caused by MTSS can be effectively treated by an ultra-conservative endoscopic approach.