18例鼻窦骨化纤维瘤的手术治疗探讨

Surgical treatment of ossifying fibroma of paranasal sinuses in 18 cases

目的探讨鼻窦骨化纤维瘤的临床特点及手术治疗方案。方法回顾性分析郑州大学第一附属医院2011年01月~2017年06月治疗的18例鼻窦骨化纤维瘤患者的临床资料,其中男11例,女7例,年龄8-37岁,平均年龄15岁。15例经鼻内镜下行鼻窦骨化纤维瘤切除,3例经鼻内镜下联合头皮冠状切口入路手行鼻窦骨化纤维瘤切除。结果本研究18例患者,14例完全切除,4例部分切除。面部肿胀,眼球突出和移位,鼻塞,鼻出血和头痛症状均有不同程度的改善,嗅觉减退2例中1例恢复,1例无改善;视力下降5例,2例提高,余3例无改善,但未加重。未出现失明、脑脊液鼻漏、颅内感染和大出血等严重并发症。随访时间0.5~7年,12例无复发,4例带瘤生存,2例复发。结论鼻内镜下及鼻内镜联合头皮冠状切口进路手术适合大部分鼻窦骨化纤维瘤患者手术,此手术经路具有保护鼻腔鼻窦结构、功能和面部美容等优点,但要求术者有较高内镜解剖知识和手术技能。

Objective To explore the clinical features and surgical treatment of ossifying fibroma of paranasal sinuses. Methods Clinical data of 18 patients suffering from ossifying fibroma of paranasal sinus surgically treated in our department from Jan 2011 to June 2017 were analyzed retrospectively. Of them, 11 were male and 7 were female, with an age range of 8 to 37 years （average age 15 years）. Tumor resection was performed via nasal endoscopic approach in 15 cases, and nasal endoscopic approach combined with coronal incision in 3. Results In this study, complete tumor resection was achieved in 14 cases and partial resection in 4. Clinical symptoms including facial swelling, exophthalmos, dislocation of eyeball, nasal obstruction, epistaxis and headache were improved in varying degrees. Of two patients with hyposmia, olfaction returned to normal in one. Of 5 cases with impaired vision, visual acuity got improved in 2 and kept unchanged in 3. No serious complications such as blindness, cerebrospinal fluid rhinorrhea, intracranial infection and hemorrhage occurred. All patients had been followed up for 6 months to 8 years. The results showed no recurrence in 12 patients, recurrence in 2 and survival with residual tumor in 4. Conclusion With advantages of protection of sinusal structures and function, as well as facial esthetic, endoscopic sinus surgery combined with scalp coronal approach if necessary maybe eligible for most patients with ossifying fibroma of paranasal sinuses. However, it requires surgeons with wealth of knowledge about endoscopic anatomy and high surgical skills.