累及鼻颅底区域鼻腔鼻窦骨源性良性肿瘤的鼻内镜手术治疗

Endoscopic surgery of sinonasal benign osteogenic tumors with involvement of nasal skull base region

目的探讨包括骨瘤、骨化纤维瘤、骨纤维异常增殖症在内的累及鼻颅底区域鼻腔鼻窦骨源性良性肿瘤鼻内镜手术治疗策略。方法经鼻内镜治疗鼻腔鼻窦骨源性良性肿瘤140例,包括骨瘤116例,骨化纤维瘤14例,骨纤维异常增殖10例。手术方式包括:单纯鼻内镜手术95例,影像导航辅助鼻内镜手术24例,鼻内镜联合鼻外入路21例。结果患者均顺利完成手术,未发生严重并发症。骨瘤均彻底切除。骨化纤维瘤12例得到彻底切除,2例有病变残留。骨纤维异常增殖症10例采取姑息性手术,术后面部外观得以恢复,病变对周围组织地压迫症状得以缓解。术后随访6~36个月,骨瘤术后无复发,骨化纤维瘤术后复发2例,骨纤维异常增殖症1例术后视力无改善,其余患者症状得到不同程度的缓解。结论骨瘤、骨化纤维瘤及骨纤维异常增殖是鼻窦常见的良性纤维骨性病变。三者临床症状相似。高分辨率CT和(或)MRI是早期诊断的重要手段。影像导航引导鼻内镜并必要时联合鼻外入路手术是治疗该类疾病的有效方法。手术时机及手术方式的选择应依据病变类型、患者症状、肿瘤位置及范围综合考虑。

Objective To explore and discuss the treatment strategy of benign osteogenic tumors with involvement of nasal skull base area, including osteoma, ossifying fibroma and fibrous dysplasia. Methods 140 patients with benign fibro-osseous lesion of naso-siunses were treated surgically, including 116 cases of osteoma, 14 cases of ossifying fibroma and 10 cases of fibrous dysplasia. Surgical methods include simple nasal endoscopic surgery in 95 cases, image navigation assisted nasal endoscopic surgery in 24 cases, nasal endoscopy combined with external nasal approach in 21 cases. Results No serious complications occurred in all cases who underwent different operations. All osteomas were completely removed. Ossifying fibromas were completely removed in 12 cases, except 2 cases with residual lesions. All cases of fibrous dysplasia were received the palliative surgery, and the facial appearances of the patients were recovered and the compressive symptoms of the surrounding tissues were relieved. The follow-up period ranged from 6 to 36 months. No recurrence was found in patients with osteoma; recurrence occurred in 2 cases ossifying fibroma; the symptoms of fibrous dysplasia get different degree of ease, except 1 patient with visual loss remained unchanged. Conclusion Osteoma, ossifying fibroma and fibrous dysplasia are common benign osteogenic lesions of paranasal sinuses. High resolution CT and （or） MRI are important means for early diagnosis. Endoscopic sinus surgery under the guidance of image navigation or combined with external nasal approach is an effective method for the treatment of these diseases. The choice of operation opportunity and surgical methods should be based on the type of lesion, the patient＇s symptoms, the location and scope of the tumor.