鼻内镜下泪前隐窝入路治疗上颌窦良性病变

目的经鼻内镜下泪前隐窝入路治疗上颌窦良性病变,并探讨其适应证、并发症及手术方式。方法回顾性分析43例经鼻内镜下泪前隐窝入路治疗上颌窦良性病变的病例,其中术前及术后病理确诊的上颌窦内翻性乳头状瘤15例,窦内病变镜下检出菌丝或孢子的真菌性上颌窦炎8例,上颌窦囊肿12例,上颌窦后鼻孔息肉6例,上颌窦异物2例。所有病例手术前均行鼻窦冠状位或水平位CT扫描。患者在局麻下以下鼻甲前缘为中心切口,解剖内移鼻泪管-下鼻甲瓣经泪前隐窝进入上颌窦腔处理上颌窦内病变,复位鼻泪管-下鼻甲瓣,缝合手术切口并行下鼻道开窗。结果 43例患者术中均完全清除窦内病变,术后随访6～24个月,下鼻甲形态愈合良好,术腔上皮化,无溢泪、面部麻木等并发症。2例上颌窦内翻性乳头状瘤术后6个月局部复发,原手术入路切除,随访1 8个月无复发。3例术后鼻腔粘连,局部分离,随访12个月无复发。结论经鼻内镜下泪前隐窝入路进入上颌窦是一种微创、安全、有效的处理上颌窦良性病变的手术方式,可作为鼻内镜下经中鼻道行上颌窦自然口开窗无法彻底切除窦内病变组织的首选治疗方法。

Endoscopic resection of benign lesions in maxillary sinus via anterior nasolacrimal recess approach

Objective To report the experience of endoscopic resection of maxillary sinus benign lesions via the anterior rtasolacrimal recess approach, and to discuss the indication and the clinical outcome of this surgical procedure. Methods 43 hospitalized patients, were enrolled in the study. As for the maxillary lesions, pathological examination identified as inverted papilloma （IP） in 15, fungal maxillary sinusitis in 8, maxillary cyst in 12, antrochoanal polyp in 6, and foreign body of maxillary sinus in 2. Preoperative sinus coronal and axial CT scans were done in all patients. The operation was carried out under local anesthesia. In this approach, an incision was made in the front part of inferior turbinate to make the flap, the nasolacrimal duct was moved inwards, and the lesion in the maxillary sinus was removed. Then, the nasolacrimal duct and inferior turbinate flap was reset. Finally, fenestration was made in the inferior nasal meatus. Results The maxillary lesions were removed completely in all 43 patients via this approach. The postoperative follow-up time ranged from 6 to 24 months. The inferior turbinates were in good shape, and sinus cavities were epithelized without epiphora, facial numbness and other complications. Two IP patients had local recurrence 6 months after operation, received reoperation via original approach and none recurred after following up of 18 months. Three patients had postoperative nasal cavity adhesion, and got healed by partial separation without recurrence. Conclusion Endoscopic resection of maxillary benign lesions via the anterior nasolacrimal recess approach is minimally invasive, safe, and effective. It can be used as a preferable method when the maxillary benign lesions can not be completely removed via endoscopic middle meatal approach.