经鼻内镜筛窦纸板进路眶内手术

目的探讨经鼻内镜筛窦纸板进路手术治疗眶内各种疾病的可行性并确立临床处理的基本原则.方法经鼻内镜进路眶内手术10例眶内异物取出术4例、球后海绵状血管瘤切除术1例、眶内侵犯或转移的恶性肿瘤切除术5例.结果眶内异物取出术3例成功,1例失败;球后海绵状血管瘤1例完整切除;鼻咽癌眶内转移1例手术切除+放射治疗后随访4年无复发,视力恢复至0.6;其他眶内恶性肿瘤4例,手术后随访1～4年均健在.10例手术后1例视力损伤,9例均保留原有视力,其中3例失明病例中2例视力有一定程度的恢复.结论位于视神经内侧的某些占位性病变可以经鼻内镜筛窦纸板进路完成.当代先进的放射治疗技术为眶内恶性肿瘤的保守性手术创造了条件.

Orbital surgery by transnasal endoscopic ethmoidal-lamina papyracea approach

Objective To explore the feasibility of transnasal endoscopic surgery to treat some kinds of diseases within orbit by ethmoidal-lamina papyracea approach, and put forward the basic principle of surgical management. Methods A total of 10 cases undergone the endoorbital operation by transnasal endoscopic ethmoidal-lamina papyracea approach, including foreign body 4 cases, sponge haemangioma 1 case,invaded and metastatic carcinoma 5 cases. Results Successful removing of foreign body from endoorbital for 3 cases, and 1 failure. One case of sponge haemangioma was removed completely. One case of metastatic tumour from nasopharyngeal carcinoma was resected, with no relapse and vision recovered to 0.6 during follow-up period of 4 years. Four cases of invaded carcinoma from ethmosphenoidal sinus were resected completely. Followe- up for 1-4 years showed no relapse. Conclusion The endoorbital region inside the optic nerve can be controlled by transnasal endoscopic ethmoidal-lamina papyracea approach. The advanced radiotherapy provides favourable conditions for conservative surgery of endoorbital carcinoma.