蝶窦区病变外科手术径路之探讨(附50例报告)

EXPLORATION OF SURGICAL APPROACH OF THE LESION OF SPHENOID SINUS FIELD (WITH A REPORT OF 30 CASES)

目的:探讨切除蝶窦区病变的良好手术径路。方法:根据病变种类的不同,分别采用:(1)用鼻内窥镜经单侧鼻腔入路治疗双侧蝶窦病变;(2)腭部粘膜"T"形瓣翻揭+硬腭开窗入路;(3)扩大的鼻侧切开+鼻锥翻揭入路; (4)颅面联合径路;(5)骨折外移鼻中甲行鼻中隔蝶窦入路。结果:本组50例,术中视野较为开阔、清晰。因减少了手术盲目性,本组未出现医源性并发症。蝶窦区良性病变37例中,术后随访3年未见复发。蝶窦区恶性肿瘤13例中经随访, 3年存活率为61.5%(8/13),5年存活率为46.1%(5/13)。结论:为了减少手术并发症,根据蝶窦的不同病变而采取不同的手术径路是合理的。

Objective: To explore the good surgical opproaches of the dissection of the lesion of sphenoid sinus. Method: According to the type of the lesion, five surgical pathways as following were adopted: (1) bilateral sphenoid sinus lesion was treated through single lateral nasal cavity pathway under the nasendoscopy; (2) hard palate windowing pathway by overturn of the ' T' form mucosa flap of palate; (3) enlarged lateral rhinotomy and overturn of nasal pyramid pathway; (4) combined cephalofcial approach; (5) nasal septum sphenoid sunus pathway by fracturing and moving outwards the middle trubinate.Results: All of the 50 cases had a broad and clear surgical field. Because the blindness was minimized, no complicatioa appeared. Of the 37 cases of benign primary lesions of sphenoid sinus, none recured. Of the 13 cases of malignant lesion of sphenoid sinus field, the three - year survival rate was 61.5% (8/13) and the five- year survival rate was 46.1 % (8/13) .Conclusion: In order to reduce the complication, it is reasonable to adopt different surgical approache based on the type of the lesions.