两种鼻内镜额窦手术方式的临床评价

Clinical evaluation of two approaches for transnasal endoscopic frontal surgery

目的对鼻内镜额窦手术Wormald术式与筛泡前径路术式进行临床比较与评价。方法慢性额窦炎行功能性鼻内镜额窦手术患者50例70侧。随机分为2组：A组（Wormald术式）24例32侧；B组（筛泡前径路术式）26例38侧。结果所有患者均随访6-12个月。①Wormald术式组有效率90．63％（29／32），筛泡前径路术式组有效率84．21％（32／38），2组比较P〉0．05。②额窦开放术后随访3个月，以额窦口直径〉0．5cm为标准，A组84．38％（27／32），B组78．95％（30／38），两组比较P〉0．05。③手术时间为A组平均54．32min，B组平均58．51min。④手术并发症为A组鼻泪管损伤1例；B组筛前动脉损伤1例，术后下眼睑瘀斑2例。结论对于2种手术径路的临床应用，可以依据鼻窦解剖、术者经验和手术器械的不同而定。但就鼻窦解剖特点而言，如鼻丘气房发育良好或钩突上端附着判断困难，则采取Wormald术式较好；如钩突上端附着于眶内壁或鼻丘气房发育小，则采取筛泡前径路术式较好。手术中如能将两者有机结合应用则更好。

Objective To evaluate the advantages and disadvantages between Wormald＇s approach and the anterior ethmoidal bulla approach in transnasal endoscopic frontal surgery. Methods 50 cases （70 sides） who underwent transnasal endoscopic frontal surgery for chronic frontal sinusitis were divided into two groups randomly： 24 cases （32 sides） in group A （wormald＇s approach） and 26 cases （38 sides） in group B （anterior ethmoidal bulla approach）. Results All patients were followed up for 6 to 12 months. ①Therapeutic efficacy： the effective rate was 90.63% in group A and 84.38% in group B （P〉0.05）. ②After 3 months, those who with frontal ostium 〉 5mm was 84.38% in group A and 78.95% in group B （P〉0.05）. ③Operation time： the average time was 54.32 rain in group A and 58.51 min in group B. ④Complications： nasolacrimal duct was injured in 1 case in group A; 2 cases of ecchymosis of lower lid and 1 case of injury of anterior ethmoid artery were observed in group B. Conclusions＇ We can select the two approaches according to the sinus anatomy, clinical experience, and surgical instruments. Wormald＇s approach would be better if agger nasi cell is well developed, or the attachment ofuncinate process is uncertain, or lack of special surgical instruments. If the superior portion of uncinate process attached to the medial orbital wall or agger nasi cell were poorly developed, anterior ethmoidal bulla approach would be preferable. It is recommended to combine these two approaches of endoscopic frontal surgery.