鼻内镜下不同手术径路额窦开放术的临床分析

A Clinical analyze of different approaches of transnasal endoscopic frontal sinus surgery

目的探讨不同手术径路额窦开放术的疗效,总结额窦开放的策略及技巧,以提高额窦开放的成功率。方法回顾分析我科2003年9月～2010年9月间经鼻内镜行额窦开放术496例(718侧),其中钩突径路额窦开放术232例(348侧),鼻丘径路额窦开放术264例(370侧),术后随访6～18个月。比较术中术后并发症及术后疗效。结果①两组患者均随访6～18个月,平均随访12个月。钩突径路组有效率91.67%,鼻丘径路组有效率92.70%,两组比较差异无统计学意义(x^2=0.268,P>0.05);②手术并发症:钩突径路组脑脊液鼻漏1例(1侧),筛前动脉损伤2例(2侧),单纯眶周青紫5例(6侧),术后窦口狭窄7例(10侧);鼻丘径路组鼻泪管损伤1例(1侧),单纯眶周青紫5例(7侧),术后窦口狭窄8例(9侧)。结论以钩突上端和以鼻丘气房为标志均能准确定位额窦开口,并行额窦开放术,二者各有其优点,可以依据鼻窦解剖、术者经验来选择。当然,手术中如能将两者有机结合应用则更好。

Objective To observe therapeutic effect of transnasal endoscopic forontal sinus （FS） surgeries with differential surgical approaches, summarize the skills of FS opening, and improve its success rate. Methods 496 patients （718 sides） with transnasal endoscopic FS surgery from 2003 to 2010 were retrospectively studied, which were performed in 232 patients （348 sides） of surgical procedure through uncinate process and 264 patients （370 sides） were treated through agger nasi cell. The intra-operative complications are compared, and the postoperative complications and efficacy were also analyzed during the follow-up of 6 to 18 months. Results They were followed-up 6-18 months, average 12 months, Tile effective rates of surgical procedure through uncinate process and agger nasi cell are 91.67% and 92.70%, respectively. The difference between the two rates is not statistically significant x^2=0.268, P〉0.05）. Surgical complications：l case （1 side）with cerebrospinal fluid rhinorrhea, 2 cases （2 sides）with anterior ethmoid artery injury, 5 cases （6 sides）with simply periorbital bruising in the surgical procedure through uncinate process and 7 cases （10 sides）osteal stenosis at frontal sinus orifice in postop. There werel case （1 side）with nasolacrimal duct injury, 5 cases （7 sides）of simple periorbital bruising in the surgical procedure througll agger nasi cell and 8 cases （9 sides）osteal stenosis at frontal sinus orifice in postop. Condusion The two approaches with uncinate process or agger nasi cell can accurately locate the FS opening, and perform well the FS surgery. Both of them have their advantages, and can be chosen by sinus anatomy and the experience of the surgeon. Organic combination of both can be better certainly.