36例鼻眶沟通性黏液囊肿的手术治疗分析

目的 探讨应用鼻内镜手术治疗鼻眶沟通性黏液囊肿的效果和联合外路手术的适应证。方法 回顾性分 析接受手术治疗的鼻眶沟通性黏液囊肿患者的病历资料，分析手术入路和治疗效果。结果 纳入36例患者的54个 副鼻窦黏液囊肿，包括额窦29个、筛窦21个、蝶窦2个、上颌窦2个。囊肿侵犯眼眶外上/外下象限6例，内上/内下象 限30例。22例（61.1%）采用鼻内镜手术，均为囊肿侵犯眼眶内上/内下象限。14例（38.9%）采用鼻内镜-外路联合手 术，其中8例侵犯眼眶内上/内下象限，6例侵犯眼眶外上/外下象限。2种手术术后眼球突出等症状均明显缓解。外 路手术出现脑脊液漏1例，鼻内镜手术出现中鼻甲粘连1例。随访12~61个月，手术后窦口再狭窄的发生率为8.3% （3/36），均发生在额窦手术后。鼻内镜手术未见囊肿复发，鼻内镜-外路联合手术1例复发。结论 鼻内镜手术治疗 鼻眶沟通性黏液囊肿安全、可行，对于囊肿在额窦外侧远端、侵犯眼眶外上/外下象限、额筛窦囊肿伴厚壁骨性间隔 者，可选择鼻内镜-外路联合手术治疗。

Analysis of surgical outcomes of 36 cases of paranasal sinus mucocoeles with intraorbital extension

Objective To evaluate the postoperative results of endoscopic approach for the treatment of paranasal sinus mucoceles with intraorbital extension, and to determine the indications of combined external approach. Methods Data of patients with paranasal sinus mucoceles and orbital involvement treated by endoscopic with/without combined external surgery were retrospectively collected, and the surgical approach and treatment effect were analyzed. Results A total of 36 patients (54 mucoceles) were collected in this research, including 29 frontal sinus, 21 ethmoidal sinus, 2 sphenethmoidal sinus and 1 maxillary sinus. Mucoceles caused adjacent bone wall destruction and intraorbital extension, including 6 cases involving the superior/inferior quadrant of the lateral orbit and 30 cases involving the superior/inferior quadrant of the medial orbit. Twenty-two (61.1%) patients underwent transnasal endoscopic sinus surgery, all of them were mucoceles with intraorbital extension to the superior/inferior quadrant of the medial. Fourteen (38.9%) patients underwent combined endoscopic and external surgery, including 6 cases with intraorbital extension to the superior/inferior quadrant of the lateral and 8 cases with intraorbital extension to the medial. The symptoms such as proptosis and vision loss were significantly alleviated after two kinds of operation. Cerebrospinal fluid leak occurred in 1 case after external surgery, middle turbinate adhesion occurred in 1 case after endoscopic surgery. The patients were followed up for 12-61 months. The incidence of ostium restenosis was 8.3% (3/36), all of which occurred after frontal sinus surgery. There was no recurrence of mucoceles in the endoscopic approach, and the recurrence rate of mucoceles in the treatment with combined approach was 7.1%. Conclusion Transnasal endoscopic sinus surgery is an effective method for most paranasal sinus mucoceles with orbital involvement. For laterally localized frontal mucoceles, involving the superior/inferior quadrant of the lateral orbit, or multiple adjacent frontoethmoidal mucoceles with thick bone septum, combined endoscopic and external surgery is an option.