经鼻内镜扩大鼻丘进路额窦手术的探索

Transnasal endoscopic frontal sinus surgery using expanded agger nasi approach

目的探索鼻内镜下改良鼻丘人路治疗额窦病变的手术方法。方法从2009年1月开始前瞻性收集中山大学附属第一医院住院行鼻内镜下改良鼻丘入路额窦手术的患者资料，包括一般情况、术中所见、术后症状、内镜检查结果及术后并发症情况。结果从2009年1月到2010年8月共进行了19例改良鼻丘人路额窦手术，其中慢性鼻-鼻窦炎17例，13例（76．5％）痊愈，3例（17．6％）好转，总有效率为94．1％，1例（5．9％）无效；额窦前筛内翻性乳头状瘤2例，治疗后痊愈。随访6～24个月，中位数随访时间16个月。无严重并发症发生，无术后额隐窝粘连，4例额隐窝组织增生、狭窄。结论鼻内镜下改良鼻丘人路术中对额隐窝和额窦的暴露较好，术野宽敞，术后粘连少，额窦引流通畅，疗效确切。

Objective To explore the feasibility of endoscopic modified agger nasi approach for the surgical treatment of frontal sinus diseases. Methods The data of patients undergoing modified agger nasi approach for frontal diseases were prospecitvely collected since January 2009, including demographic data, findings at surgery, presence of postoperative symptoms, endoscopic appearance of the fi＇ontal recess and sinus, and complications. Results Nineteen patients were enrolled from January 2009 to August 2010. Seventeen patients had chronic rhinosinusitis, in which 13 patients （76. 5% ） completely healed, 3 patients （ 17.6% ） improved and 1 patient （5.9%） failed. Two patients had fi＇ontal sinus and anterior ethmoid sinus inverted papilloma, with no recurrence. The patients were followed up from 6 to 24 nlonths, medium 16 months. No severe complication occurred. No frontal recess adhesion was found. Four sides of frontal recess showed stenosis caused by tissue hypertrophy. Conclusion The modified agger nasi approach provides excellent access to frontal recess and frontal sinus, with good effect for preventing re-stenosis after surgery.