垂体瘤切除术后鼻窦黏液囊肿形成临床分析

Nasal sinus mucoceles after hypophysectomy

目的探讨垂体瘤切除术后鼻窦黏液囊肿形成的原因、好发部位及治疗方法。方法回顾性分析我科1998年1月至2007年8月诊治的7例垂体瘤切除术后鼻窦黏液囊肿患者的临床资料。结果7例中,筛窦黏液囊肿2例、额窦黏液囊肿2例、额窦、筛窦黏液囊肿3例。鼻内镜下鼻内进路或鼻内外联合进路行囊肿切除术,一次手术治愈,随访1～3年无复发。结论垂体瘤切除术后发生鼻窦黏液囊肿多因手术改变了鼻腔结构以及术后复查不及时造成中鼻道狭窄、粘连、鼻窦开口阻塞引起。垂体瘤切除术后鼻窦黏液囊肿好发于筛窦、额窦或额窦和筛窦并发。鼻内镜下鼻内进路或鼻内外联合进路行囊肿切除术是首选的治疗方法。手术中建立鼻窦鼻腔的通畅引流,术后定期检查可有效减少垂体瘤切除术后鼻窦黏液囊肿的形成以及预防囊肿切除术后复发。

OBJECTIVE To explore the causes, predilection sites and treatment of nasal sinus mucoceles after hypophysectomy. METHODS The clinical data of 7 cases with nasal sinus mucoceles after hypophysectomy diagnosed and treated in our Department from Jan.1998 to Aug.2007 were retrospectively studied. RESULTS The mucoceles were located at ethmoid sinus in 2 cases, frontal sinus in 2 cases, frontal and ethmoid sinuses in 3 cases. All of the 7 cases underwent mucocelectomy under nasal endoscope or a combined endoscopic intranasal and extra-nasal approach. No recurrence was found after follow up for 1 to 3 years. CONCLUSION The causes of nasal sinus mucoceles after hypophysectomy are the change of the anatomic structure of nasal cavity after surgery. The stenosis, adhesion of middle nasal meatus or obstruction of the sinus ostium are found in all the patients. Intranasal endoscopic surgery or combined with extra-nasal approach is the first choice for nasal sinus mucoceles.