影像导航辅助鼻内镜下治疗鼻窦骨纤维异常增殖症的应用体会

Application experience of endoscopic treating sinus bone fibrous dysplasia under navigation guidance

目的:探讨影像导航辅助鼻内镜下切除鼻窦骨纤维异常增殖症的手术方法及经验。方法:回顾性分析2006-03-2011-12期间收治的4例鼻窦骨纤维异常增殖症患者,其中男2例,女2例;年龄19～55岁,平均38岁。原发于上颌窦内3例,原发于蝶窦内1例。术前行16排CT扫描并行三维重建,全部病例均采用影像导航鼻内镜下电钻磨除鼻窦腔内的异常骨纤维组织,实现骨纤腔内的轮廓化。结果:4例患者均在影像导航鼻内镜下准确找到病变并磨除大部分病变组织。3例患者术后头痛、鼻塞、面部不适等症状逐渐消失。1例上颌窦内骨纤维异常增生患者术后3个月再次出现面部肿胀疼痛,保守治疗效果不佳,复查CT示左侧上颌窦炎,再次行手术,术中发现上颌窦内有大量骨渣,考虑为首次手术后术腔未冲洗干净,导致上颌窦口堵塞,再次扩大上颌窦口,冲洗上颌窦腔,术后行鼻腔及上颌窦冲洗,1个月后症状完全消失。所有患者术后均未见复发。结论:正确的使用影像导航系统辅助鼻内镜下治疗鼻窦骨纤维异常增殖症,术中结合电钻磨除鼻窦腔内的异常骨纤维组织,实现骨纤腔内的轮廓化,可以使患者获得彻底、安全、有效的治疗。

Objective： Research for surgical methods and experience of sinus fibrous dysplasia treatment by auxiliary nasal endoscopy image navigation. Method： Retrospective analysis of the records of 4 patients from March 2006 to December 2011 who were diagnosed as fibrous dysplasia of nasal sinuses, 2 male and 2 female, aged from 19 yrs to 55 yrs and average age was 38 yrs; 3 of them were destroyed of sinus floor, the other who had the bone fiber of sphenoidal sinus. By using 16 multi slice spiral CT and 3D reconstruction, the 4 cases were all treated by drill grinding abnormal fibrous tissue in the nasal sinus cavities with auxiliary nasal endoscopy image navigation, to achieve contour in the bone fiber cavities. Result： Lesions of 4 cases were accurately found and grinded under auxil- iary nasal endoscopy image navigation. For 3 patients, headache, nasal congestion, facial discomfort and other symptoms have gradually disappeared after operation. However, one patient with sinus floor destroyed suffered facial swelling and pain 3 month after operation, with ineffective conservation treatment outcomes. After CT rescan, it showed that there were a large number of bone residue in maxillary sinus during the re-operation. The reason was that the surgical cavity was not rinsed off which leaded to maxillary sinus congestion. With the methods of expansion of the maxillary sinus, flushing the cavity, and postoperative nasal and maxillary sinus rinse, symptoms dissappeared 1 month later without recurrence. Conclusion： Patients with fibrous dysplasia of nasal sinuses are treated thoroughly, securely, and effectually, by drill grinding abnormal fibrous tissue in the nasal sinus cavities with auxiliary nasal endoscopy image navigation, to achieve contour in the bone fiber cavities.