慢性鼻窦炎、鼻息肉的修正性鼻内窥镜手术治疗

Revision endoscopic sinus surgery on chronic sinusitis and polyps

目的 :探讨修正性内窥镜鼻窦手术治疗复发性鼻窦炎、鼻息肉的临床意义。方法 :采用内窥镜鼻窦手术对 112例复发性鼻窦炎、鼻息肉患者进行了修正性治疗 ,术中采用 Messerklinger技术、Stryker切削器 ,并辅以控制性降压。结果 :病变清除满意 89例 (79.5 % ) ,手术欠满意 17例 (15 .2 % ) ,6例失败。并发脑脊液鼻漏 1例、眼眶血肿 4例、术后溢泪 3例 ,大出血 12例。结论 :修正性手术适用于鼻窦内窥镜手术后出现的术腔随访清理难以控制的鼻窦炎病变。但该术对于堵塞、粘连性病变效果较好 ,鼻息肉病效果欠佳。中鼻甲残根和后鼻孔上穹窿为手术重要的安全标志 ,术前 CT扫描可以减少并发症的发生。

Objective:To study the indications,surgical landmarks,surgical significance,complications and operative avoidance of revision endoscopic sinus surgery on chronic sinusitis and polyps.Method:We performed revision endoscopic sinus surgery on 112 cases of chronic sinusitis and polyps under controlled hypotension anaesthesia by using the Messerklinger technique and Stryker debrider.Result:89 cases were successful and 17 unresolved,6 failed,all the complications consist of cerebrospinal fistula in one, orbital hematoma in four,increased tearing in three and profuse bleeding in 6 patients.Conclusion:Revision endoscopic sinus surgery was advised in case of sinuous obstruction caused by uncontrolled lesions under postoperative care,which can do good for adhesion and obstruction except nasal polyposis.The reminant of the middle turbinate and the upper arch of choana were helpful operative landmarks.Preoperative CT scan decrease the complications.