鼻内镜下鼻窦颅底区域手术

目的探讨鼻内镜下鼻窦颅底区域疾病手术的价值。方法回顾性总结鼻腔内镜下鼻窦颅底区域手术病例98例,其中脑脊液鼻漏12例,垂体瘤44例,浆细胞瘤1例,圆柱瘤1例,内翻性乳头状瘤9例,骨纤维异常增殖症1例,鼻咽纤维血管瘤2例,侵入颅内的巨大蝶筛窦囊肿2例,孤立性蝶窦病变21例,视神经管骨折5例。结果脑脊液鼻漏12例全部修补成功。44例垂体瘤患者,术后结果优良35例,有效9例,无效0例。1例颅底巨大骨纤维异常增殖症以及1例浆细胞瘤、1例圆柱瘤、9例内翻性乳头状瘤均全切成功,随访1、2a无复发。2例鼻咽纤维血管瘤患者随访2a无复发。2例巨大蝶窦囊肿随访2a无复发。21例孤立性蝶窦病变术后主要症状全部消除。5例视神经减压手术术后4例视力恢复到0.2￣0.7,1例无明显改变。结论鼻内镜下处理颅底病变安全,效果确实,避免了外部切口的创伤。

Application of endoscopic treatment in the surgery of disease involving sinus and skull base

Objective To evaluate the value of endoscopic surgery of disease involving sinus and skull base. Methods We summarized retrospectively 98 cases of endoscopic surgery of disease involving sinus and skull base in which there were 12 cases of cerebrospinal rhinorrhea, 44 cases of pituitary adenomas, 1 case of plasmacytoma, 1 case of cylindroma, 9 cases of inverted papilloma, 1 case of large osteoma in the anterior skull base, 2 cases of nasopharyngeal angiofibroma, 2 cases of large sphenoethmoidal cyst involving cranum, 21 cases of isolated sphenoid lesions, 5 cases of optic canal fracture. Results All the cerebrospinal rhinorrhea were mended successfully. 35 of 44 pituitary adenomas had good results, 9 of 44 cases effective, and no invalid. The large osteoma and the plasmacytoma, 1 case of cylindroma, 9 cases of inverted papilloma were all excised successfully, and no recurrence for 2-years follow-up. There were no recurrence of the nasopharyngeal angiofibroma and the large sphenoethmoidal cyst for 2-years follow-up. The main symptoms of the isolated sphenoid disease had disappeared after surgery. 4 of 5 cases of optic canal fracture had better visual to 0.2-0.7; one case had no obvious change. Conclusion Endoscopic surgery was a safe, effective method for the lesions invoving the skull base.