鼻内窥镜在鼻腔鼻窦恶性肿瘤诊断和治疗中的价值

Value of endoscopic sinus surgery in the diagnosis and treatment of sinonasal malignancises

目的探讨鼻内窥镜手术诊断和治疗鼻腔鼻窦恶性肿瘤的价值。方法鼻腔鼻窦恶性肿瘤43例,分别采取鼻内镜下肿瘤切除术、鼻内窥镜辅助下经上颌窦肿瘤切除术以及鼻内窥镜辅助下鼻侧切鼻腔鼻窦恶性肿瘤切除术等。结果 76.7%(33/43)的病例是在鼻内镜下直接取得病理,23.3%(10/43)病例是在鼻内镜辅助下柯陆氏入路进入上颌窦取得病理确诊。能够在鼻内窥镜下将鼻腔鼻窦肿瘤切除的占34.9%(15/43),在鼻内窥镜下取病理后进一步放疗或化疗的占20.9%(9/43),在鼻内窥镜辅助下经上颌窦将肿瘤切除的占11.6%(5/43),在鼻内窥镜辅助下经鼻侧将肿瘤切术的占20.9%(9/43),在鼻内窥镜下取病理后进一步上颌骨切除术的占11.6%(5/43)。结论鼻内窥镜手术对于明确鼻腔鼻窦恶性肿瘤的诊断,缓解症状、提高患者生存质量具有重要价值,并为其治疗提供了新的术式。

Objective To explore the value of endoscopic sinus surgery in the diagnosis and treatment of sinonasal malignancies.Methods Forty three cases of sinonasal malignancies were removed with the methods of endoscopy,Caldwell-Luc operation combined with endoscopy,nasal lateral approach combined with endoscopy and maxillary bone surgery,respectively.Results 76.7%（33/43） of the tumors were diagnosed under endoscopy,and 23.3%（10/43） of the other tumors were diagnosed through Caldwell-Luc route assisted by endoscopy.34.9%（15/43） of the tumors were removed completely under endoscopy.20.9%（9/43） of the patients were treated with chemotherapy or radiotherapy after diagnosed under endoscopy.11.6%（5/43） of the tumors were removed with Caldwell-Luc operation combined with endoscopy.20.9%（9/43） of the tumors were removed through nasal lateral approach combined with endoscopy.11.6%（5/43） of the tumors needed to remove the partial or complete maxillary bone.Conclusion Endoscopic managenment of sinonasal malignancies is very important in making clear diagnosis,relieving symptoms and increasing patients＇ living level,which offers a new less invasive alternative than resection by an open approach.