鼻内镜下鼻窦骨瘤切除术后疗效分析

Analysis on the curative effect of endoscopic resection of sinus osteoma

目的探讨经鼻内镜手术治疗鼻窦骨瘤的手术方法及治疗效果,总结鼻窦骨瘤手术经验。方法回顾性分析2012年5月—2016年6月于贵州省人民医院耳鼻咽喉头颈外科经鼻内镜手术治疗的11例鼻窦骨瘤的临床资料,其中鼻塞5例、溢泪2例、眼球凸出1例、头痛1例、视力下降2例。所有患者术前均行鼻窦三维CT检查,确定骨瘤的位置和侵犯范围,完善视力、视野、眼压、视神经诱发电位(VEP)及光学相干断层扫描(OCT)等眼科检查,麻醉方式均为全身麻醉及控制性降压,手术均在鼻内镜下完成,术中根据鼻窦CT范围选择具体的手术方式,选择恒定的解剖结构作为标志,尽量达到骨瘤的完全切除,同时采用鼻中隔带蒂黏膜瓣覆盖术腔,促进术腔上皮化,术后1周复查鼻窦CT,术后定期门诊复诊。结果术后1周复查鼻窦CT显示肿瘤彻底切除9例,部分切除2例,随访26~76个月,患者较术前症状明显好转,其中头痛、鼻塞及溢泪症状均消失,2例视力下降患者中1例视力有部分提高,但1例眼球凸出患者在术后1年复发,转外院治疗,现已失访,其余患者均未见肿瘤复发。结论鼻内镜手术治疗鼻窦骨瘤安全、有效、微创,术前鼻窦CT可为鼻内镜手术提供可靠的保障,术中选用恒定的解剖结构定位肿瘤边界,以求骨瘤完全切除。

Objective To investigate the surgical method and therapeutic effect of endoscopic surgery for anasal sinus osteoma,and to summarize the experience of surgery for nasal sinus osteoma.Methods It was retrospectively analyzed for the clinical data of 11 cases of osteoma of nasal sinus including 5 cases of nasal obstruction,2 cases of epiphora,1 case of exophthalmos,1 case of headache and 2 cases of visual impairment.These patients were treated by endoscopic surgery in the Guizhou Provinical People’s Hospital from May 2012 to June 2016.All patients were preoperatively examined by three-dimentional computed tomography(3-D CT)in order to judge Osteoma’s location and scope of invasion.The patients were examined for visual acuity,visual field,Optic nerve evoked potential(VEP)and optical coherence tomography(OCT)before surgery.The anesthesia methods were general anesthesia and controlled hypotension.All operations were performed under nasal endoscopy.During the operation,specific surgical methods were selected according to the CT scope of the sinus,and the constant anatomical structure was selected as a marker to achieve the complete the resection as far as possible to remove osteoma.Nasal septum pedicled mucosal flap was used to cover the operative cavity to promote the epithelialization of the operative cavity.The patient was reexamined with sinus CT one week after surgery,which received regular outpatient follow-up after operation.Results CT scan of nasal sinuses showed that 9 cases were completely resected and 2 cases were partially resected after operation.All patients were followed up for 26~76 months.The preoperative symptoms of the patients improved significantly including the symptoms of headache,nasal obstruction and epiphora disappeared.1 case had partial improvement in vision,but 1 case about exophthalmos recurred after a year,which was transferred to another hospital.The patient has been lost to follow-up,and no tumor recurrence was found in the other patients.Conclusions Endoscopic surgery is safe,effective and minimally invasive in the treatment of osteoma of nasal sinus.Preoperative CT of nasal sinus can provide reliable guarantee for endoscopic surgery.Constant anatomical structure is selected to locate the tumor boundary during operation in order to achieve complete resection of osteoma.