鼻内镜下鼻腔外侧壁切开治疗上颌窦良性病变27例

目的探讨经鼻内镜鼻腔外侧壁切开入路治疗上颌窦良性病变的效果。方法上颌窦良性病变27例(29侧)。在鼻内镜下,首先从下鼻甲前缘行鼻腔外侧壁切开,分离出鼻泪管后形成鼻泪管-下鼻甲瓣,内移形成上颌窦入路;然后彻底清除上颌窦病灶;最后复位鼻泪管-下鼻甲黏膜瓣,并行下鼻道开窗。结果术后均经病理证实为良性病变。随访6～18个月,治愈24例(26侧)、好转2例、无效1例。鼻内镜检查:术腔上皮化,术后患者下鼻甲形态良好。除1例6个月后复发,另1例有轻微面部麻木外,其余病例均无溢泪、鼻腔干燥等手术并发症。结论鼻内镜下鼻腔外侧壁切开治疗上颌窦良性病变安全、有效、成功率高、并发症少,是常规鼻-上颌窦(联合)开窗困难的上颌窦良性病变可选治疗方法。

Endoscopic nasal lateral wall dissection approach for benign lesions of maxillary sinus in 27 cases

Objective To evaluate the effect of endoscopic nasal lateral wall dissection （ENI,WD） on benign maxillary sinus diseases. Methods Twenty-seven patients with benign maxillary sinus diseases were involved. The ope- ration began with a mucosal incision in front of inferior turbinate（IT） and then the lacrimal duct（LD） was dissected, thus a IT-LD flap was formed. The flap was placed inwardly and the maxillary sinus lesion was removed under endoscope. The inferior antrostomy was performed when the flap was repositioned. Results Postoperative pathological findings confirmed that the lesions were all benign. The follow-up period ranged from 6 months to 18 months. Twenty-four patients were cured and two patients showed apparent efficacy, while one patient showed inefficacy. Postoperative inferior turbi- hate was formed well, and well-epithelized operative cavities were observed. Only one patient relapsed 6 months after the operation and another has a mild facial numb. There were no such complications as epiphora or nasal drying. Conclusions The ENLWD approach was an alternative method for benign lesions of maxillary sinus because of its high success rate and low complications. （Chin J Ophthalmol and Otorhinolaryngol,2011,11：345-347 ）