鼻内镜下孤立性蝶窦良性疾病的诊治

Diagnosis and treatment of isolated benign sphenoid sinus disease under nasoendoscopy

目的提高对孤立性蝶窦良性疾病症状、体征的认识和首诊准确率。方法分析32例孤立性蝶窦良性疾病的临床表现和手术方法与途径及病人总的治疗与恢复情况。结果经鼻内镜蝶窦开放术,治愈27例,其中17例手术后症状立即消失,10例术后3-5d症状消失;好转5例,仅感轻微头痛和嗅觉失灵,鼻内镜见窦口黏膜肿胀。术后1个月复诊窦口开放率为93.75%(30/32),所有病例均随访6-48个月无病变及症状复发,CT/MRI复查未见窦腔病变。未再次手术。结论孤立性蝶窦良性疾病经CT或MRI等高清晰度的影像学检查加之以鼻内镜检查可明确诊断,且鼻内镜下经蝶筛隐窝入路手术具有视野清晰、安全有效的优点。

Objective To detail the underlying symptoms and signs of patients with isolated sphenoid sinus benign disease and enhance the initial diagnostic accuracy. Methods The clinical features, surgical techniques and approaches, treatment and recovery of 32 patients with isolated sphenoid sinus benign diseases were analyzed. Results After endoscopic sphenoidotomy, 27 cases were cured （the symptoms disappeared immediately in 17 cases, 10 cases in 3 - 5 days after operation）, and 5 cases still suffered mild headache and hyposmia, but their ostium mucosa were swelling under nasal endoscopic examination. The rate of opening ostium was 93.75 % （30/32） after one month of operation. No cases recurred after follow-up for 6 -48 months. Conclusion Nasoendoscopy and CT/MRI scan could provide a precise diagnosis for isolated sphenoid sinus disease, and endoscopic surgery is of wide operation view and safety.