鼻内镜下泪前隐窝入路手术治疗复杂上颌窦病变

目的探讨在复杂上颌窦病变中应用鼻内镜下泪前隐窝入路手术彻底切除上颌窦病变的可行性、疗效及并发症。方法回顾性分析2008年6月至2010年6月采用鼻内镜下泪前隐窝入路治疗26例不同类型的复杂上颌窦病变的临床资料。其中鼻内翻乳头状瘤17例:出血坏死性息肉4例:复发性上颌窦炎伴囊肿3例:复发性鼻息肉1例:上颌窦骨瘤1例。所有病例术前均行CT检查,内翻乳头状瘤行MR检查。手术先去除鼻腔和其他鼻窦病变,开放并扩大上颌窦自然窦口,再行泪前隐窝入路清除上颌窦病变,术后下鼻道开窗术。观察术中情况、并发症及术后疗效。结果全部病例均能良好显露上颌窦各壁,彻底切除病变组织,无鼻泪管损伤、无鼻甲萎缩、坏死及面部麻木等并发症。随访12~36个月,内翻乳头状瘤有2例复发,1例术后3个月上颌窦口上方与眶底交界处复发,经局部切除后随访1年,另1例术后7个月筛窦局部复发并累及眶纸板,再次手术切除病灶及局部眶纸板,随访8个月,未见复发:其余病例均未见复发。所有病例术后临床症状逐渐消失,下鼻甲形态良好,上颌窦腔上皮化。结论鼻内镜下泪前隐窝入路能够充分显露上颌窦腔,彻底切除上颌窦内的病变,手术操作方便,手术创伤相对较小,并发症少,术后观察方便,疗效满意,对于复杂的上颌窦病变,特别是良性病变,是一个值得选择的术式。

Treatment of complex maxillary sinus disease through the frontal recess of tears operation under endoscope

Objective To explore the feasibility,efficacy and complications of the frontal recess of tears operation to completely remove maxillary sinus lesions under endoscope in the complex maxillary sinus disease.Methods From June 2008 to June 2010,we retrospectively analyzed the clinical data of 26 cases getting different types of the complex maxillary sinus disease which were treated by the frontal recess of tears operation.Among 26 cases: 17 cases got inverted papilloma: 4 cases got hemorrhagic and necrotic polyps: 3 cases got recurrent maxillary sinusitis with cysts: 1 case got recurrent nasal polyps: 1 case got maxillary sinus osteoma.All patients underwent CT examination.The cases with inverted papillomaline underwent MR examination.Nasal and other sinus lesions were firstly removed and the natural maxillary sinus ostium were opened and expanded.Then the maxillary sinus lesions were removed by the frontal recess of tears operation.Following this operation,the inferior meatus after fenestration were performed.The complications and postoperative effect were observed.Results In all patients,every maxillary sinus walls were well exposed.The lesions were completely removed.The operations have done well without nasolacrimal duct injury,turbinate atrophy and necrosis,complications such as the facial numbness.All the cases had 12-36 months follow-up.Two cases with inverted papillomaline showed recurrence.One of them got a recurrence in the junction of top of the mouth of the maxillary sinus and the bottom of the orbital after surgery for 3 months.After the surgical removal of the lesions and next 1 year follow-up,no recurrence was found.Another case of them got a local recurrence in the ethmoid sinus involving the orbital ethmoid cardboard after surgery for 7 months.After the surgical removal of the lesions and local orbital cardboard and next 8 months follow-up,no recurrence was observed.The recurrence was not found in all other cases.All patients’ symptoms disappeared and the shapes of the inferior turbinate were good.The sinus mucosa was covered by the mucosal epithelium.Conclusion The frontal recess of tears operation under endoscope can fully expose the maxillary sinus cavity and completely remove the lesions within the maxillary sinus.The operation is conveniently done with relatively small surgical trauma,and has fewer complications and satisfactory outcome.For the complex maxillary sinus diseases,especially in benign lesions,is a worthy selection of surgical procedures.