蝶窦良性侵袭性病变的临床诊治分析

目的　探讨蝶窦良性侵袭性病变的临床特点及内镜治疗。方法　回顾性分析19例蝶窦良性侵袭性病变的临床资料。19例均行内镜下经蝶入路病变切除。结果　内 翻性乳头状瘤6例，骨化纤维瘤7例，软骨瘤2例，嗜酸性肉芽肿4例。临床症状以头痛及视觉障碍多见。影像学共同特征是蝶窦骨壁破坏，周围结构受不同程度侵袭。术中发生脑脊液鼻漏1例，I期修复成功。术后全部患者无眶内及颅内并发症。随访3～5年，手术全切除15例无复发；次全或大部分切除4例，1例病灶无增大；3例复发，其中1例再次手术治愈，2例恶变并颅内转移死亡。结论　蝶窦良性侵袭性病变呈恶性肿瘤样行为，具有侵袭性、易复发性。内镜下彻底切除病变是防止复发的重要治疗方法。但有别于恶性肿瘤，应注意避免扩大切除范围。

Clinical diagnosis and treatment of benign invasive lesions of sphenoid sinus

OBJECTIVE To summarize the clinical characteristics and endoscopic treatment of benign invasive lesions of sphenoid sinus. METHODS 19 cases of clinical data of benign invasive lesion of sphenoid sinus were retrospectively analyzed. All of these 19 cases were given lesion resection via endoscopic transsphenoidal approach. RESULTS The lesions consisted of inverted papilloma（6 cases）, ossifying fibromas（7 cases）, chondroma（2 cases）, eosinophilic granuloma（4 cases）. Headache and visual disturbances were the common clinical symptoms. The common features of the imaging was destruction of sphenoid bone wall, invasion of surrounding structures of different degrees. Cerebrospinal fluid leakage occurred in l case,which was successfully repaired during the endoscopic operation. There were no postoperative orbital or intracranial complications.All patients were followed up for 3-5 years. 15 cases after thorough resection had no recurrence. But among the 4 cases of subtotal or partial resection, there was 1 case without lesion increase and other 3 cases of recurrence of which 1 was cured after reoperation and 2 cases became malignant and died because of Intracranial metastasis. CONCLUSION Benign invasive lesions of sphenoid sinus was similar to malignant neoplasma, with invasive behavior and easy recurrence characteristics. Endoscopic resection is an important treatment to prevent relapse. But unlike cancer, we should avoid taking extended resection.