6例孤立性蝶窦肿瘤的诊断与手术治疗

Diagnosis and surgical treatment of six cases with isolated sphenoid sinus neoplasm

目的 :研究孤立性蝶窦肿瘤的诊断和治疗。方法 :6例孤立性蝶窦肿瘤 ,全部病人均有头痛症状 ,其中5例有眼 神经症状 ,所有病人均经CT证实为孤立性蝶窦占位性病变 ,并在鼻内窥镜下取病检。其中良性 2例 ,包括乳头状腺瘤 1例 ,内翻性乳头状瘤 1例。恶性肿瘤 4例 ,包括蝶窦低分化鳞癌 2例 ,腺样囊性癌 1例 ,内翻性乳头状瘤恶变 1例。 1例乳头状腺瘤行鼻内窥镜下蝶窦开放术 ,其余 5例经鼻外筛窦径路手术。结果 :2例良性肿瘤中 ,1例乳头状瘤治愈随访 40月 ,1例内翻性乳头状瘤手术后随访 15月症状改善。 4例恶性肿瘤中 3例术后放疗观察18— 2 8月无复发。 1例失访。结论 :鼻内窥镜、影像学检查对本病的诊断起重要作用 ,并对手术有指导意义。良性肿瘤以鼻内窥镜手术为主。恶性肿瘤以手术加放疗治疗 ,鼻外筛窦径路是治疗此类恶性肿瘤的优选术式。

Purpose:To study the diagnosis and surgical treatment of isolated spheniod sinus neoplasms. Methods:6 cases with isolated sphenoid sinus neoplasm were analyzed. All patientes had headache, five had visual-neural symptoms. In all cases, the isolated space-occupying lesions in sphenoid sinus were verified by CT scan, and biopsies were made under nasal endoscopy before operation. Two cases were benign, including 1 inverting papilloma, 1 papillary adenoma. Four cases were malignant, including 2 sphenoidal sinus low differentiated carcinoma, 1 adenoidocystic carcinoma, 1 inverting pallilloma with malignant change. 1 case with papillary adenoma underwent endoscopic surgery, and 5 cases underwent surgery by external approach. Results:Among the 4 malignant cases, 3 patient did not recurren after surgery and radiotherapy for 18 to 28 months. 1 patient was lost to follow-up. Among the 2 benign cases, 1 case with papillary adenoma was cured after 40 months, the symptoms of the other was improved after 15 months. Conclusions:Nasal endoscopic and imaging study is very important for the diagnosis and surgery of lesions in isolated sphenoid sinus neoplasm. The benign lesion is operated by nasal endoscope, and malignant lesion is treated by operation and radiotherapy. External ethmoidectomy is a method of choice for malignant lesions.