经鼻内镜两种径路额窦手术的临床分析

Clinical analysis of two approaches for endoscopic frontal sinus surgery

目的分析经鼻内镜鼻丘径路术式与钩突径路术式额窦开放手术的疗效,个性化评估合适的手术径路。方法 35例、51侧诊断为额窦病变,根据术前CT显示鼻丘气房气化程度及钩突上缘附着部位将其纳入两组:鼻丘径路术式16例、22侧,钩突径路术式19例、29侧。结果①术中均顺利找到额窦口开放额窦,未出现严重颅底及眼部并发症;②术后随访6个月以上,主观症状均有不同程度改善,两组病例的有效率分别为87.50%(14/16)及89.47%(17/19)。术后6个月鼻内镜下检查,术腔愈合分级以额窦口直径>0.5 cm为标准,两组的有效率分别为81.82%(18/22)及75.86%(22/29),差异无统计学意义(P>0.05)。结论鼻内镜下额窦开放术经鼻丘径路和钩突筛泡基板前径路皆可有效处理额窦病变。术前CT扫描选择合适径路有利于手术顺利完成,降低手术并发症。术者的经验与窦口区的合理处理有利于术后的恢复。

Objective To analyze the results of two approaches for endoscopic frontal sinus surgery and to evaluate a right and individual approach. Methods Thirty-five patients （51 sides） who underwent endoscopic frontal sinus sur- gery were divided into two groups according to the vaporization of the agger nasi cell and attached location of the un- cinate process from pre-operative CT scans. The agger nais approach group treated 16 patients （22 sides）, and the uncinate process and anterior ethmoidal bulla approach group treated 19 patients （29 sides）. Results The ostium of the frontal sinus was identified in all the patients without serious basicranial or orbital complications. All the patients were followed up by endoscopy in 6 to 13 months. Among them, the effective rate was 87.50% and 89.47%. Endoscopic scores based on the openness of the frontal ostium, the effective rate was 81, 82% and 75.86% respectively （ P 〉 0.05 ）. Conclusion The endoscopic frontal sinus surgery, by both the agger nasi cell ap- proach and the unciate process and anterior ethmoidal bulla approach is effective for the frontal diseases. CT scans can remind a better approach for frontal sinus surgery. Operation technique and experience and proper management of the frontal recess are keys for recovery.