侵犯眶内鼻窦囊肿的手术治疗

Surgical management of sinus cyst invaded the orbit

目的探讨改良眉弓径路联合鼻内镜技术在侵犯眶内的哑铃形筛窦囊肿手术中的应用及疗效分析。方法2002年8月N2012年4月我科收治的7例侵犯眼眶的哑铃形巨大筛窦囊肿患者，全麻下采用改良眉弓切口，鼻内镜辅助下沿眶壁分离并切除眶内囊肿，然后采用鼻内镜囊肿造袋术，切除囊肿。结果7例患者术中眶内及鼻窦囊肿均能充分暴露，并在直视下全部去除。术后无脑脊液鼻漏、眶筋膜损伤和眶内、颅内感染等并发症。术后随访6-18个月，均未见复发。结论采用改良眉弓径路联合鼻内镜行侵犯眶内的哑铃形筛窦囊肿手术，增加了手术的精确性和安全性，切口短，瘢痕小，切除彻底，降低复发率，减少对面部美观的影响，是治疗侵犯眶内的巨大哑铃形筛窦囊肿的有效术式之一。

OBJECTIVE To explore the clinical application and analyze the curative effect of the modified eyebrow approach combined with nasal endoscopicapproach in the surgery for ethmoid sinus cyst （dumbbell shape） invaded the orbit. METHODS In our clinical department, seven cases who were diagnosed huge ethmoid sinus cyst invaded the orbit underwent general anesthesia surgery from August 2002 to April 2012. At first, the eyebrow incision was made. Then with the help of the nasal endoscope, their orbital cysts were separated and cut off along the orbital wall. Afterthat, the mucoceles of nasal sinus were removed under nasal endoscope. RESULTS The orbits and the nasal sinus cysts of the seven cases could be fully exposed and be completely removed under direct vision without postoperative complications, such as cerebrospinal rhinorrhea, orbital fascia injury, orbital infection or intracranial infection. All the cases were followed up for 6 to 8 months, and no recurrence was found. CONCLUSION The lesion was excised completely with only a short incision and a small postoperative scar. It is apparent that the modified eyebrow approach combined with the nasal endoscopic approach can make the operation safer and more accurate, reduce the recurrence rate and decrease the negative influence on facial appearance. It＇s one of the effective ways to management ethmoid sinus cysts invaded the orbit.