鼻内镜下泪前隐窝入路切除上颌窦良性复发性病变疗效分析

Endoscopic resection of recurrent begin lesions in maxillary sinus via anterior prelacrimal recess approach

目的 探讨鼻内镜下泪前隐窝入路切除上颌窦良性复发性病变的优越性。 方法 收集2014年1月至2015年2月单县中心医院耳鼻咽喉科收治的21例上颌窦良性病变术后复发患者，包括上颌窦息肉8例，上颌窦内翻性乳头状瘤7例，真菌性上颌窦炎6例。所有患者术前均行鼻内镜检查、鼻窦冠状位及轴位CT，若为单侧上颌窦病变，加行鼻窦MRI检查。经检查所有病变经中鼻道手术均无法彻底清除。手术均在控制性降压全麻下进行，选择泪前隐窝手术入路。随访8~12个月，观察术后恢复情况。 结果 21例患者均经泪前隐窝入路行病变清理术，术中可充分暴露上颌窦各壁，病变清理彻底。术后病理7例内翻性乳头状瘤术后病理未见恶变。其余8例上颌窦息肉术后病理符合鼻息肉术后复发。术后患者病变无复发，保留了鼻腔结构和功能，术后无面颊部麻木、溢泪等并发症。 结论 泪前隐窝入路切除上颌窦良性复发性病变，可充分暴露视野，彻底切除病变的同时，还保持了正常的鼻腔形态和功能，损伤小，并发症少，符合鼻内镜手术的微创理念。

Objective To investigate the advantages of endoscopic resection of recurrent begin lesions in maxillary sinus via anterior prelacrimal recess approach. Methods We reviewed the data from the patients who were enrolled in our department from January 2014 to February 2015. Among them, the data of 21 patients, who had recurrent begin lesion of Maxillary Sinus including 8 begin polyp, 7 inverted papilloma and 6 fungal maxillary sinusitis, were adopted according to our criterion. All patients were given the pre-surgical preparations, including endoscopic examination, coronal and axial position CT scan and MRI for single side lesions. Through the examination, the patients who could be treated via middle nasal meatus were excluded. The general anesthesia and blood pressure control in operation were applied. Anterior prelacrimal recess approach was adopted to expose the surgical view. Results The clear surgical view and complete resection were achieved in all the patients. After 8-12months follow up, there were no recurrence and complications such as facial numbness or epiphora. Conclusion The anterior prelacrimal recess approach for resection of recurrent begin lesions in maxillary sinus can provide wide surgical field exposure and complete resection of the lesion, and also has the advantages of keeping the morphology and function of nasal sinus, less damage and less complication. It accords with the concept of minimally invasive nasal endoscopic surgery.