以星状裂解剖标志定位经筛泡前径路行额窦开放术

Frontal sinus surgery via an approach anterior to ethmoid bulla positioned by tristar of grooves as an anatomic landmark

目的实施以星状裂解剖标志定位经筛泡前径路行额窦开放术,评价该术式的有效性及安全性。方法对225例(407侧)慢性额窦炎患者行星状裂解剖标志定位的筛泡前径路额窦开放术。术前常规鼻窦CT扫描,确定额窦自然开口与钩突及筛泡的关系。术中保留筛泡,依据星状裂解剖标志定位额窦开口行额窦开放手术。结果 220例患者按该手术步骤开放了额窦自然开口;5例(8侧)术中暴露额窦开口困难,通过经皮额窦穿刺,注水时在内镜下观察,确定额窦自然开口位置后继续手术获得成功。无一例出现筛前动脉破裂出血和前颅底骨折等术中并发症,2例患者纸样板损伤出现眶周血肿。术后随访6～12个月,293侧(72%)可见额窦窦口开放良好,完全上皮化。201例患者(89%)主观感觉症状缓解。结论以星状裂为解剖标志定位经筛泡前径路行额窦开放术术中能较准确地寻找额窦开口,提高了额窦手术成功率,可减少手术并发症的发生。

Objective To evaluate the effectiveness and safety of frontal sinus surgery via an approach anterior to ethmoid bulla positioned by the anatomic landmark named tristar of grooves. Methods Frontal sinus surgery was practiced on 225 patients （407 sides ） with chronic frontal sinusitis via an approach anterior to ethmoid bulla positioned by tristar of grooves. Preoperative routine sinus CT scan was used to determining the relationship of natural ostium of the frontal sinus with ethmoid buUa and uncinate process. Ethmoid bulla was retained to position natural ostium of the frontal sinus. Results The frontal natural osfium was opened by the surgical procedure in 2 2 0 cases. In the other 5 patients （ 8 sides ） , the exposure of frontal ostium was difficult and got success in determining the location of the frontal natural ostium by percutaneous injection of frontal sinus. No major complications occurred such as ethmoid artery bleeding, skull fracture. Orbital hematoma occurred in 2 cases due to injury of the medial orbit walll. Followed up for 6 to 12 months , 293 sides （ 72 % ） showed good frontal sinus opening and complete epithelialization. Subjective symptoms were relieved in 201 patients （89 % ） . Conclusion This surgical procedure can locate the frontal sinus natural osfium accurately, therefore, can improve the success rate of frontal sinus surgery and reduce surgical complications.