双侧扩大蝶窦成形术在蝶窦病变中的应用

Application of expanding bilateral sphenoid sinus plasty in the treatment of sphenoid sinus diseases

目的探讨双侧扩大蝶窦成形术在蝶窦病变中的应用价值。方法 2012年12月～2017年6月,解放军南京总医院耳鼻咽喉头颈外科采用双侧扩大蝶窦成形术治疗蝶窦病变患者42例,随访6～53个月,观察其手术疗效及并发症。结果 15例难治性蝶窦炎患者术后蝶窦口开放良好,术腔清洁,均治愈;其余患者均彻底切除病灶,其中1例真菌性蝶窦炎伴颅内感染并发热患者术后予抗真菌治疗3个月后颅内病灶吸收,2例蝶窦癌、1例蝶窦脊索瘤患者及1例嗅神经母细胞瘤侵犯蝶窦及颅内患者术后均行放疗。42例患者术后除2例嗅觉减退及1例视力下降无明显好转外,余症状均明显缓解,未发生动脉性鼻出血、嗅觉减退及鼻中隔穿孔等并发症,术后患者术腔黏膜均上皮化良好,黏膜完全上皮化时间平均8. 6周。2例蝶窦癌患者分别随访10、14个月,蝶窦脊索瘤患者随访10个月,均未复发; 1例嗅神经母细胞瘤侵犯蝶窦及颅内患者随访8个月未复发。所有患者随访至今,均未发现蝶窦口再闭。结论采用双侧扩大蝶窦成形术治疗蝶窦病变,术野暴露清晰,蝶窦开放充分,术腔上皮化时间短,手术安全性高,术后随诊处置直观,是一种值得推广的手术方法。

Objective To explore the application of expanding bilateral sphenoid sinus plasty in the treatment of sphenoid sinus diseases.Methods From Dec 2012 to June 2017,42 patients suffering from sphenoid sinus diseases were treated by expanding bilateral sphenoid sinus plasty in our department.All the patients were followed up for 6 to 53 months for evaluating the surgical effect and complications.Results 15 cases of refractory sphenoid sinusitis were cured with good opening of sphenoid sinus orifice and clean cavity.The rest of the patients underwent complete resection of the lesions.One case of fungal sphenoid sinusitis complicated with intracranial infection and fever received postoperative antifungal therapy for 3 months.Two cases of sphenoid sinus carcinoma and one of sphenoidal chordoma as well as one of olfactory neuroblastoma with sphenoid sinus and intracranial invasion received postoperative radiotherapy.Of all the 42 cases,the symptoms were relieved after operation except hyposmia in 2 and impaired vision in one.No complications such as nasal bleeding,olfactory hypofunction and perforation of nasal septum occurred.Follow up revealed good mucosal epithelization in all the patients with an average epithelization time of 8.6 weeks.Two patients with sphenoid sinus cancer were followed up for 10 months and 14 months,respectively.One with sphenoid sinus chordoma was followed up for 10 months,and another one of olfactory neuroblastoma with sphenoid sinus and intracranial invasion was followed up for 8 months.So far,recurrence occurred in none.Conclusion With advantages of clearly exposed surgical field,full opening of sinus cavity,high surgical safety,short epithelialization time and intuitionistic postoperative follow-up,the expanding bilateral sphenoid sinus plasty is worth popularizing for the treatment of sphenoid sinus diseases.