慢性鼻窦炎鼻息肉经鼻内镜鼻窦手术并发症及其防范

Chronic sinusitis and nasal polyps：surgical complications and avoidance for endoscopic sinus surgery

目的探讨慢性鼻窦炎鼻息肉经鼻内镜鼻窦手术并发症发生的原因及其防范补救措施。方法采用回顾性分析111例住院病例围术期观察和出院后随访观察，并对并发症防范及补救措施进行评价。结果本组手术并发症总的为10例（9％）。其中术中出血1例（1％），眶纸板及眶筋膜损发生2例（1．8％），内直肌损伤导致复视发生1例（1％），术腔粘连闭塞发生3例（2．7％），鼻中隔穿孔发生2例（1．8％），泪道损伤发生1例（1％）；本组没有其他严重手术并发症的发生。结论鼻内镜鼻窦手术（FSS）并发症在临床上并不少见，应高度重视；严格筛选手术适应证，规范化的围术期用药和处理，术前仔细检查患者和阅读CT片，术后定期随访，适时采取补救措施，对降低手术并发症的发生和保障医疗安全十分重要。

Objective To analyze the surgical complication in patients with chronic sinusitis and nasal polyps, and discuss the risk factors and preliminary strategies for prevention of complications. Methods Review the surgical complication in patients with chronic sinus and nasal polyps after endoscopic sinus surgery（ESS）. All patients were followed-up more than 6 months. Results There were 9% cases（ 10/111 ） had surgical compli- cations after ESS, which include bleeding in 1 case （1% ）, orbital complications in 2 cases （1.8%）, diplopia in 1 case（ 1% ） ,nasal bind in 3 case（2. 7% ） ,perforation of nasal septum in 2 cases（ 1.8% ） ,harm of nasolacrimal duct in 1 case （ 1% ）. Conclusion It is more that occur rate of surgical complication due to ESS than traditional operation. Peri-operative complications are more common in nasal polyps and severe chronic sinusitis pa- tients, especially when they accompanied with hypertension. The corresponding strategies should be taken to re- duce complications in ESS, which include controlling the hypertension effectively, selecting the indication suitable to ESS, reading to CT before operation, monitoring closely after operation. It is important to reduce surgical skills and not enlarging the surgical scale blindly.