鼻内镜下鼻腔外侧壁入路治疗上颌窦不同病变的疗效观察

Efficacy of endoscopic nasal lateral wall dissection approach in the treatment of maxillary sinus diseases

目的:分析鼻内镜下鼻腔外侧壁切开(切除)入路治疗上颌窦病变的临床疗效,探讨此入路的临床应用价值。方法:18例累及上颌窦病变患者中,13例(上颌窦出血坏死性息肉4例,上颌窦囊肿4例,上颌窦真菌感染3例,上颌窦含牙囊肿2例)行鼻腔外侧壁切开入路,5例(上颌窦内翻性乳头状瘤3例,鼻腔上颌窦骨巨细胞瘤1例,上颌窦梭形细胞瘤1例)行鼻腔外侧壁切除入路,术中鼻内镜直视下进入上颌窦内彻底清除上颌窦病灶,并处理鼻腔及其他鼻窦等病变。结果:随访半年以上,鼻腔外侧壁切开患者术腔上皮化,下鼻甲形态良好,病变无复发;鼻腔外侧壁切除患者术腔上皮化良好,无复发。所有患者均无面颊部麻木、溢泪等并发症。结论:鼻内镜下鼻腔外侧壁切开并保留鼻泪管和下鼻甲有利于整个上颌窦腔病变彻底清除,保留了鼻腔的生理功能;鼻腔外侧壁切除入路视野显露较理想,在累及上颌窦的内翻性乳头状瘤及上颌窦恶性肿瘤的处理上有一定的临床价值。

Objective：A retrospective analysis of the clinical efficacy on the surgery of maxillary sinus diseases via the endoscopic lateral nasal wall incision,and a discussion on the clinical application of this approach.Method：Eighteen cases of the maxillary sinus diseases diagnosed on the basis of the preoperative nasal endoscopy,CT scan or MRI,and pathologic finding.Among 13 patients underwent routine lateral nasal wall incision approach,including 4of maxillary sinus hemorrhagic and necrotic polyps,4of maxillary sinus cyst,and 3of the maxillary sinus fungal infection.Five patients underwent lateral nasal wall resection approach and thorough maxillary sinus lesions resection by nasal endoscope,including 3of inverted maxillary sinus papilloma,a nasal sinus bone giant cell tumor and a spindle cell tumor.Patients were followed up for more than half a year,and the postoperative efficacy were observed.Result：The surgical cavity of the lateral nasal wall incision approach have luminal epithelium,well shapes of inferior turbinate,no recurrence of the lesion,and the lateral nasal wall resection patients with well luminal epithelium,without recurrence.All patients had no complications such as numbness,tears,etc.Conclusion：Endoscopic incision of lateral nasal wall keep the nasolacrimal duct and inferior turbinate,help remove the entire sinus cavity lesion and retain the physiological function of the nasal cavity.Resection of the lateral nasal wall can reveal an ideal vision approach,which perform certain clinical value for the treatment of the inverted maxillary sinus papilloma and sinus cancer.