鼻内镜下治疗蝶窦非垂体源性病变53例

目的:探讨蝶窦非垂体源性病变的诊断及鼻内镜治疗方法。方法:53例蝶窦非垂体源性病变患者均经CT扫描发现蝶鞍区病变并提示了病变范围。8例局限性病变者经蝶窦前壁自然口入路完成手术,2例鼻咽纤维瘤侵犯蝶窦者经鼻中隔中线入路,其余经上鼻道或蝶筛入路暴露病变。结果:53例蝶窦非垂体源性病变中,蝶窦囊肿及脓囊肿23例、蝶窦真菌感染8例、蝶窦出血性息肉2例、垂体瘤切除术后蝶窦炎性肉芽肿1例、蝶窦乳头状瘤5例、蝶窦脑脊液鼻漏1例、蝶窦骨化纤维瘤2例、鼻咽血管纤维瘤侵犯蝶窦2例、筛蝶窦脑膜瘤1例均行鼻内镜下蝶窦开放切除病变或修补脑膜,术后症状明显改善;蝶窦内血肿并颈内动脉假性动脉瘤3例仅作鼻内镜检查,经DSA证实并行血管内介入栓塞治疗后治愈;蝶窦恶性肿瘤3例,经蝶筛入路切除蝶窦内大部分肿瘤后辅以放化疗;鼻咽癌侵犯蝶窦2例病理检查证实后行放化疗。结论:蝶窦鞍区病变以头痛、眼部症状为常见症状,CT、MRI及DSA检查对蝶窦病变的及早发现和诊断起着重要作用,鼻内镜下处理蝶窦病变径路多样,选择适当径路可达到直接、安全、微创等目的。

The management of 53 non-pituitary lesions in sphenoidal sinus by transnasal endoscopic surgery

Objective:To investigate the diagnosis and management of non-pituitary lesions in sphenoidal sinus.Method:All cases with non-pituitary lesions in sphenoidal sinus were confirmed by CT scan.Eight cases with localized lesions underwent operation by trans-sphenoidal approach.Two cases with juvenile nasopharyngeal angiofibroma with invasion to the sphenoid sinus were treated by tans-septal approach.The rest recieved operation by trans-superior meatal or trans-ethmoidal approach.Result:Forty-five of these cases underwent complete or major resection of the lesion by endoscopic sphenoid sinus surgery,including 23 cyst and pus cyst of sphenoidal sinus,8 fungal sphenoid sinusitis,2 bleeding polyp of sphenoidal sinus,1 post-hypophysectomy granulation hyperplasia of sphenoidal sinus,5 papilloma of sphenoid sinus,1 cerebrospinal rhinorrhea of sphenoid sinus,2 ossified fibroma of sphenoid sinus,2 juvenile nasopharyngeal angiofibroma with invasion to the sphenoid sinus,1 meningioma of ethmoid and sphenoid sinus.Three cases with hematoma in sphenoidal sinus and pseudoaneurysm in internal carotid artery underwent nasal endoscopic examination,and the diagnosis was established by DSA,and they received interventional therapy.Three cases with malignancy of sphenoidal sinus received major mass resection of sphenoidal sinus by trans-ethmoidal approach,and followed with radio therapy and chemotherapy.Two cases with NPC involving sphenoidal sinus were treated by radio therapy and chemotherapy after pathological examination.Conclusion:Headache and visual loss were two common symptoms for the lesions in sphenoidal sinus.Imaging study including CT,MRI and DSA is very important for the diagnosis of the lesions in sphenoidal sinus.There are various surgical pathways to deal with sphenoidal sinus diseases under nasal endoscope.The operation will be direct,safe and minimal invasive if we choose the pathway properly.