额窦引流系统及鼻内镜额窦手术研究进展

Research progress on frontal sinus drainage system and endoscopic frontal sinus surgery

鼻内镜额窦手术是鼻内镜鼻窦手术中的难点,手术风险和失败率较高,受到临床广泛关注。手术成功的重要前提是充分理解额窦引流系统,该系统包括:额漏斗、额窦口、额隐窝。额窦引流系统结构复杂,特别是额隐窝解剖变化大,解剖复杂。在对额窦引流系统和额隐窝的不断认识中,先后提出了5种分类方法:Bent and Kuhn分类、改良Bent and Kuhn分类、鼻丘-筛泡分类、欧洲鼻腔鼻窦解剖分类及国际额窦解剖分类。根据手术技巧和手术范围的不同,先后提出了Stammberger剥蛋壳技术、Friedman术式"钩突径路"额窦开放术、改良Lothrop手术等鼻内镜额窦开放技术。根据额窦开放和手术切除的范围,有Draf分型和国际额窦鼻内镜术分类两种手术分级方法。随着对额窦引流系统解剖认识的不断加深和手术器械的改进及手术技巧的不断提高,目前的鼻内镜额窦手术不再局限于某些技巧或方法,更常见的是根据额隐窝气化和解剖情况,充分切除额隐窝开放额窦。本文对额窦引流系统分类、鼻内镜下额窦手术技术及手术分级的发展和现状进行了回顾和总结,分析了鼻内镜额窦手术的相关问题,以求提高手术成功率,减少手术并发症。

Nasal endoscopic frontal sinus surgery is one of the most difficult problems in nasal endoscopic sinus surgery.And its operation risk and failure rate is high, which is widely concerned in clinic treatment.An important prerequisite for successful surgery is a full understanding of the frontal sinus drainage system, which includes the frontal funnel, frontal sinus mouth, and frontal recess.The structure of frontal sinus drainage system is complex, especially the anatomy of frontal recess.Based on the understanding of frontal sinus drainage system and frontal recess, five classification methods have been proposed: Bent and Kuhn classification, modified Bent and Kuhn classification, collicular-ethmoid classification, European anatomical classification of nasal sinus, and International Frontal Sinus Anatomy Classification.According to different surgical techniques and scopes, Stammberger eggshell peeling technique, Friedman’s "uncinate approach" frontal sinus opening and modified Lothrop surgery were successively proposed.According to the scope of frontal sinus opening and surgical resection, there are two surgical classification methods: Draf classification and international classification of endoscopic frontal sinus surgery.With the deepening of anatomical understanding of frontal sinus drainage system, the improvement of surgical instruments, and the continuous improvement of surgical skills, the current nasal endoscopic frontal sinus surgery is no longer limited to certain techniques or methods, but it is more common to fully remove the frontal recess and open the frontal sinus according to the vaporization and anatomy of the frontal recess.In this paper, it was reviewed and summarized for the classification of frontal sinus drainage system, the development and status quo of nasal endoscopic frontal sinus surgery technology and surgical classification.And the related problems of nasal endoscopic frontal sinus surgery was analyzed to improve the success rate of surgery and reduce surgical complications.