额窦病变手术径路选择及疗效分析

Surgical approaches and effect for frontal sinus diseases

目的：探讨额窦病变手术径路选择，并分析疗效。方法回顾性分析28例（30侧）额窦病变，包括额窦炎、额窦囊肿、脓囊肿、骨瘤等，其中17例采用鼻内镜手术，11例采用鼻内镜联合鼻外双径路。结果术后随访3～12个月，全部病例症状改善或消失，没有出现严重手术并发症。结论鼻内镜下手术无法完全处理或内镜不能安全达到的额窦后壁或额窦病变部位于超过瞳孔中央假想垂直线外侧的可采取鼻内镜联合额窦前壁开窗双径路手术。术前充分阅读 CT，选择适当的手术方式，术中仔细辨认解剖结构，精确定位，可避免严重并发症的发生。术前的综合治疗及术后的定期复查、清理术腔也至关重要。

Objective To investigate the surgical approaches and curative effect for frontal sinus diseases.Methods A retrospective analysis was done into 28 cases （30 sides）of frontal sinus diseases,including frontal sinusitis,frontal sinus mucoceles,abscess mucoceles and osteoma,of which 17cases were treated by endoscopic sinus operation and 11 cases by the combination of nasal endoscopic surgery with external nasal surgery.Results All patients were tracked for up to 3-l2 months.The symptoms in all the cases were found to lessen or disappeared,and there were no serious opera-tive complications.Conclusion The cases that cannot be radically treated by endoscopic operation and the cases where nasal endoscope cannot safely reach the frontal sinus posterior wall or the pupil outside frontal cell should be treated by the combination of nasal endoscopic surgery with frontal sinus anterior wall fenestration.Before the operation,the doc-tor should carefully read CT and choose the proper operative approach;during the surgery,the doctor should carefully identify the anatomical structure,accurately locate the diseased spot and skillfully carry out the operation so as to avoid the occurrence of serious complications.Adequate attention should be paid to pre-operative comprehensive treatment and post-operative regular reexamination and cavity debridement.