鼻内镜手术治疗鼻-眶-颅底骨纤维异常增殖症4例

目的 探讨鼻内镜手术治疗鼻-眶-颅底骨纤维异常增殖症的方法及预后。方法 回顾分析4例经鼻内镜手术治疗的累及鼻腔鼻窦、眼眶、颅底的骨纤维异常增殖症的临床资料。其中男1例, 女3例, 5～17岁, 中位年龄13岁。临床表现为鼻塞、头痛、流涕、嗅觉减退, 其中1例伴双眼视力下降。病变累及筛骨4例, 蝶骨2例, 额骨2例, 上颌骨2例, 颧骨、颞骨、枕骨1例。结果 4例均在鼻内镜下经鼻将病变组织大部分切除。随访13～123个月, 鼻塞、头痛、流涕均逐渐消失, 嗅觉好转, 鼻腔黏膜上皮化良好。1例视力下降者术后视力略有好转, 但4年后视力再次下降行二次手术。4例均未出现手术并发症, 效果满意。结论 鼻内镜手术治疗鼻-眶-颅底骨纤维异常增殖症安全、有效, 损伤小, 不仅可以恢复鼻腔鼻窦生理功能、改善临床症状, 而且对预防及治疗并发症也有积极作用。

Nasal endoscopic surgery for fibrous dysplasia involving rhino-orbito-skull base:a report of 4 cases

Objective To investigate the treatment method and prognosis of fibrous dysplasia involving rhino-orbito-skull base. Methods The clinical data of 4 cases of fibrous dysplasia involving rhino-orbito-skull base treated with nasal endoscopic surgery were retrospectively analyzed. There was 1 male and 3 females aging from 5 to 17 years with a median age 13 years. Their clinical manifestations included headache, rhinorrhea, hyposmia and nasal obstruction, except of visual deterioration in 1 case. The primary sinus involved was the ethmoid (4), sphenoid (2), frontal (2), maxillary (2), and skull (1). Results All the patients were followed up of 13-123 months. The symptoms such as headache, rhinorrhea and nasal obstruction disappeared after the operation, olfactory dysfunction was better, and the nasal cavity epithelization was well. The case of visual deterioration was re-operated 4 years later because of recurrence. All the patients had no complications and had satisfied outcome. Conclusion The nasal endoscopic surgery is safe, effective and results in less injury for fibrous dysplasia involving rhino-orbito-skull base. It not only can repristinate nasal sinuses physiological function and improve clinical symptoms, but also has positive effect on prevention and treatment of complications.