经鼻内镜手术治疗鼻腔鼻窦骨源性良性肿瘤——附14例报告

Endoscopic sinus surgery for benign osteogenic tumors of nasal cavity and paranasal sinuses——A clinical analysis of 14 cases

目的探讨经鼻内镜手术治疗鼻腔鼻窦骨源性肿瘤的可行性及手术技巧。方法回顾性分析1998年6月-2012年5月经鼻内镜手术治疗的14例鼻腔鼻窦骨源性肿瘤的临床资料。所有患者均于术前行鼻窦高分辨CT（HRCT）检查,确定肿瘤的位置和侵犯范围。手术均在全身麻醉下进行,经鼻内镜手术11例,鼻内镜辅助鼻外径路手术3例。其中行肿瘤彻底切除9例,部分切除5例。结果所有患者术后平均随访5年7个月。2例侵及眶内及前颅窝的骨化纤维瘤患者分别于术后2个月和8个月复发,接受第2次手术后1例病变基本控制,目前仍在随访中,另1例去外院接受了第3次鼻颅脑联合手术再复发,仍在观察中;1例骨母细胞瘤患者采用经鼻经额联合径路内镜手术,但侵入前颅窝相当于鸡冠处的肿瘤仍有残留,术后2年患者因左侧眶内及颅内肿物复发去外院行开颅手术后失访;其余患者随访至今未见复发。所有病例均未发生其他严重并发症。结论鼻腔鼻窦骨源性肿瘤局限于鼻腔鼻窦者经鼻内镜手术可彻底切除;但当肿瘤破坏颅底突入颅腔或肿瘤侵及颈内动脉、视神经等重要结构时,单纯内镜下肿瘤不易彻底切除,需多学科的联合手术或其他辅助治疗。

Objective To explore the feasibility and surgical techniques of endoscopic sinus surgery for benign osteogenic tumors of nasal cavity and paranasal sinuses. Methods Clinical data of 14 patients with benign osteogenic tumors of nasal cavity and paranasal sinuses and receiving endoscopic sinus surgery from June 1998 to May 2012 in our department were analyzed retrospectively. Results Of all the 14 patients,6 were male and 8 were female,aged from 7 to 47 years with an average of 25. 1 years. The involved tumors included osteoblastoma（ n = 1）,osteoid osteoma（ n = 1）,ossifying fibroma（ n = 7）,fibrous dysplasia（ n = 1）,ethmoid osteoma（ n = 1）,frontal sinus osteoma（ n = 1） and sphenoid sinus osteoma（ n = 2）. The main clinical symptoms were nasal congestion,headache,facial pain and progressive eye bulge. Preoperative sinus high-resolution CT（ HRCT） examination was performed for all patients to analyze the tumor ＇s location and display the extent of the lesions. All surgical procedures were performed under general anesthesia. 11 patients underwent nasal endoscopic surgery and 3 patients received endoscopic surgery combined with other external approaches. Complete tumor resection was achieved in 9 cases,and partial resection in 5. All patients had been following up for an average duration of 67 months. Two cases with ossifying fibroma extenting to the orbit and anterior cranial fossa got recurred 2 months and 8 months postoperatively and underwent reoperation respectively. Of them,the lesion was controlled in one case and the other one underwent the third operation in other hospital. The osteoblastoma recurred 4 months postoperatively and the patient underwent reoperation,but still had residual tumor which extended to the crista galli of anterior cranial fossa, the patient underwent the third operation in other hospital 2 years postoperatively and then was lost to follow-up. All other patients had no recurrence, no serious complications occurred. Conclusion The surgical treatment of benign osteogenic tumors of nasal cavity and paranasal sinuses is sometimes very complex. The tumor can be completely removed by endoscopic sinus surgery when it is confined to the nasal cavity and paranasal sinus. When it extends to the cranial cavity and vital structures such as internal carotid artery or optic nerve,it is impossible to resect the lesion completely via endoscopic sinus surgery,and then multidisciplinary combined surgery or other adjuvant therapy should be considered.