导航鼻内镜下上颌窦良性骨性病变的治疗体会

Application of image navigation in maxillary sinus surgery for benign pathological bone lesions

目的探讨经导航鼻内镜下切除上颌窦良性骨性病变的治疗体会。方法回顾分析2005年10月至2010年1月治疗的上颌窦良性骨性病变8例的临床资料,术前行64排CT并三维重建,全部病例采用导航引导下手术切除,包括鼻内镜联合柯-陆氏径路及鼻内镜下经鼻下鼻道开窗径路。结果 3例为上颌窦内骨纤维异常增生症,5例为骨瘤,均在导航引导鼻内镜下成功切除了病变,其中6例经柯-陆氏径路切除病变,2例经鼻下鼻道开窗切除病变。随访半年以上,7例术后头痛、鼻塞、流脓涕、面部不适等症状逐渐消失,1例上颌窦内骨纤维异常增生症患者术后2月再次出现面部肿胀疼痛,保守治疗效果不佳,再次手术,发现上颌窦内有大量死骨,考虑为第1次手术后术腔未冲洗干净,导致上颌窦口堵塞,再次手术后症状消失。患者术后均未见复发。结论影像导航系统可以准确迅速的确定病变位置,导航鼻内镜下上颌窦良性骨性病变切除是准确、安全、微创的手术方式。

Objective To explore and evaluate the surgical treatment of maxillary sinus benign pathological bone lesions under an image navigation system. Methods The clinical data of 8 cases of maxillary sinus benign pathological bone lesions from October 2005 to January 2010 in our department were retrospectively analyzed. 64 slice CT three-dimen- sional imaging was used for diagnosis, and the Caldwell-Luc procedure and endoscopic fenestration with an image guided system were used in the operations. Results Of the 8 cases, 3 were diagnosed as fibrous hyperplasia of the bone and 5 osteoma; 6 were operated by the Caldwell-Luc procedure and 2 by endoscopic fenestration from the meatus nasi inferior. All the pathological lesions were removed by electric drill. With more than half a year follow-up, 7 cases were gradually free from the symptoms of headache, nasal obstruction and purulent nasal discharge. But 1 patient with fibrous hyperplasia of bone reoccurred, and after being operated twice, a mount of sequestra was taken out of the maxil- lary sinus which was due to the failure of clearing them out in the f＇trst operation. All the patients were healed without serious complications after the operations. Conclusion An image guided system in maxillary sinus surgery can be effectively used in locating and removing benign pathological bone lesions.