内窥镜蝶窦手术的麻醉改进和眼部并发症的预防

目的 :探讨鼻内窥镜手术治疗蝶窦病变的麻醉方法和预防眼部并发症的措施。方法 :在 6 5例蝶窦病变的手术治疗中均行局麻加经改进后的表麻 ;术中彻底止血 ,明确碟窦的位置、窦壁吸收与破坏情况 ,以及病变的部位、色泽和形状等特点 ,密切注意眼部症状 ,避免损伤视神经。结果 :随访 0 .5～ 2年。治愈 5 3例 ,复发 7例(其中内翻乳头状瘤 2例 ,慢性蝶窦炎并息肉 5例 ) ,5例失访 ,仅 5例发生眼部并发症。复发病例经再次手术而切除。结论 :在局麻加改进的表麻下能完成蝶窦内窥镜手术 ,熟悉解剖结构及熟练的手术技巧可减少眼部并发症的发生。

Choice of anesthetic method and prevention of ophthalmic complication in sphenoid sinus endoscopic surgery

Objective:To evaluate the anesthetic method and the prevention of the ophthalmic complication in endoscopic surgery for sphenoid sinus disease.Method:All 65 patients underwent local anesthesia with improved surface anesthesia. Arrest blood completely in the surgical operation. The position of sphenoid sinus, the assimilation and destruction of sinus wall, the location and the appearance of lesion were determined carefully. To avoid damaging the optic nerve, the behavior of eyes was observed intently.Result:The follow up period ranged from 6 months to 2 years. Five patients were lost to follow up.53 of 60 patients recovered. 7 patients had recurrence among them with 2 cases of inverted papilloma and 5 cases of spheniod sinusitis with nose polyp, but they were successfully resected by endoscopic endonasal sinus surgery. Ophthalmic complication occurred in 5 patients.Conclusion:Endoscopic sphenoid sinus surgery can be performed successfully under local anesthesia with improved surface anesthesia. Familiarity with the anatomic marker and variable anatomy, and meticulous surgical technique are essential for reducing ophthalmic complication.