泪道置管联合鼻内镜下上颌窦内壁扩大切除术治疗上颌窦占位性病变

目的探讨和完善鼻内镜下彻底切除鼻腔、上颌窦内占位性病变,降低术后复发率的手术方法。方法回顾分析1999年1月至2008年12月在我院经泪道置管联合鼻内镜行上颌窦内壁扩大切除术治疗的上颌窦占位性病变且随访资料完整的69例的临床资料。术中先行泪道置管,并应用动力系统切除鼻腔内瘤体,切除上颌窦内壁大部,在30°镜下于肿瘤基底部周围骨膜下剥离肿瘤,局部骨骼化,用电刀烧灼基底部残余软组织,以防止复发,术后长期随访。结果患者均在鼻内镜下随访。1例鼻内翻性乳头状瘤患者于术后4个月复查时发现后组筛窦内复发,咬除肿物后用电刀烧灼,随访至今未见复发。1例淋巴瘤术后半年死于广泛转移。其余67例经随访1~9年,未见复发,无溢泪及其他并发症,治愈率为97.10%。鼻内翻性乳头状瘤患者与对照组行Caldw ell-Luc手术或鼻侧切开术治疗相比较,治愈率差异有统计学意义(P0.05)。结论在正确选择适应证的前提下,泪道置管联合鼻内镜下上颌窦内壁扩大切除术可有效切除上颌窦占位性病变,可作为上颌窦占位性病变的首选术式。

Lacrimal passage intubation in combination with expansive resection of the inner wall of the maxillary sinus by nasal endoscopy for maxillary sinus lesion

Objective To explore a proper endoscopic surgery for maxillary sinus(MS) lesion and to decrease the recurrence after operation. Methods Since January 1999, sixty nine cases had been operated upon and followed up for 1 to 9 years(average 4.5years) .After a tube was implanted through the lacrimal passages,the lesion was removed by using XPS3000. The majority of the inner wall of MS was removed. The bony attachment of the tumor and neighbor tissues were resected by an electric scalpel. Results Recurrence was identified in one case (1.45%).The small mass of the lesion had recurrence but was completely removed. One patient with lymphoma died of metastasis within a half year after surgery. All of them had no epiphora and other complications. Conclusion When appropriate indications are selected, endoscopic surgical technique in combination with lacrimal passage implantation of a tube is proved to be a good method in treating maxillary sinus lesion.