经鼻内镜泪前隐窝径路治疗上颌窦病变

目的：探讨经鼻内镜泪前隐窝入路在上颌窦病变手术中的应用。方法回顾性分析2011年9月至2014年1月31例上颌窦病变行经鼻内镜泪前隐窝径路手术的病例资料，其中乳头状瘤19例（3例术后病理提示癌变），出血坏死性息肉5例，真菌性鼻窦炎3例，炎性息肉4例。手术采用控制性低血压全身麻醉，经鼻内镜下泪前隐窝入路切开鼻腔外侧壁进入上颌窦，清除上颌窦内病灶。结果本组31例手术均顺利清除病灶，无任何并发症。3例乳头状瘤癌变病例术后转放疗科放疗，其余均于术后5～8 d 痊愈出院。术后随访5～33个月，仅1例乳头状瘤癌变者复发。结论经鼻内镜泪前隐窝手术治疗上颌窦病变，该术式解剖并保证鼻泪管完整，可明视下清理上颌窦各壁及隐窝内病变，有利于更好地清除病变和降低复发率。

Endoscopic anterior prelacrimal recess surgery in treatment of maxillary sinus lesions

Objective To explore the application of endoscopic transnasal prelaerimal recess-maxillary sinus approach in surgery for maxillary sinus lesions.Methods A total of 31 patients with maxillary sinus lesions were treated by endo-scopic transnasal prelaerimal recess-maxillary sinus surgery between September 2011 and January 2014.Among them there were 19 cases of inverted papilloma（3 of malignant transformation）,5 cases of hemorrhagic necrotic polyps,3 cases of fungal maxillary sinusitis,and 4 cases of maxillary sinus polyps.The operation was performed under hypoten-sion anaesthesia and performed with an endoscopic transnasal lateral nasal wall approach to the maxillary sinus.Then all the lesions were completely removed under endoscopy.Results The lesions were removed totally in all 31 patients.No complications were found.Three patients with inverted papilloma canceration underwent radiotherapy after surgery.All the patients fully recovered and were discharged from the hospital in 5 to 8 days.Except one patient with papillary epi-thelioma,no recurrence occurred during the follow up periods ranging from 5 to 33 months.Conclusion Endoscopic transnasal prelacrimal recess-maxillary sinus approach can maintain the structure of nasolaerimal duct and fully expose the maxillary sinus.Lesions removed totally can greatly decrease the morbidity.