鼻内镜下经蝶窦翼管神经切断术的手术探讨

A modified endoscopic transsphenoidal vidian neurectomy

目的探讨鼻内镜下经蝶窦翼管神经切断的手术方法。方法对65例难治性高反应性鼻病患者行鼻内镜下经蝶窦单侧翼管神经切断术。依据术前翼管神经重建CT用刮匙和kerrison咬骨钳自蝶窦开口处伸入蝶窦腔,去除蝶窦前壁骨质达蝶窦底壁,切割钻头沿蝶窦底壁向外下方磨除蝶窦前壁骨质或部分蝶骨体骨质直至暴露翼管神经位于蝶窦前壁的开口,电凝翼管开口处的翼管神经及其伴行血管。结果 65例患者均准确的定位翼管神经,完成了鼻内镜下经蝶窦单侧翼管神经切断术。治疗后主观总体评价显著改善率为86.1%(56例)。结论鼻内镜下经蝶窦翼管神经切断术以蝶窦为参考标志,在蝶窦前壁、底壁和外侧壁之间定位并切断翼管神经,安全可靠,值得临床推广。

Objective To describe a modified technique for endoscopic transsphenoidal vidian neurectomy （ETSVN）. Methods A total of 65 patients with intractable nasal mucosal byperreactive rhinopathy underwent unilateral ETSVN. With the guidance of preoperative CT reconstruction of vidian nerve, the sphenoid sinus was entered under endoscope by perforating its anterior wall using antrum curet and kerrison rongeur. The sphenoidal ostium was then opened and enlarged laterally and inferiorly by cutting drill until the vidian canal （VC） exit located at the anterior wall could be clearly observed. The stumps of the nerve including accompanying vessels were cauterized using electrocoagulator. Results The vidian nerve could be precisely identified via such an endoscopic transsphenoidal approach. Unilateral ETSVN was performed in all the 65 patients. Postoperative subjective evaluation showed a total improvement rate of 86. 1%. Conclusions With neither intra-sphenoidal abscission nor entrance of middle meatus, ETSVN provides an easy, reliable and repeatable way for vidian neurectomy. Vidian canal can be located between the anterior wall, inferior wall and bottom of the sphenoid sinus.