经鼻中隔入路改良蝶窦开放术治疗孤立性蝶窦病变

Treatment for isolated sphenoidal lesions with the modified endoscopic sinus surgery on sphenoidal diseases via nasal septum approach

目的探讨经鼻中隔后端入路改良的蝶窦开放术治疗孤立性蝶窦病变的安全性、可行性及疗效。方法21例孤立性蝶窦病变患者接受鼻内镜下经鼻中隔后端入路的蝶窦开放术,必要时切除鼻中隔后端蝶嘴部分及蝶窦中隔以扩大蝶窦腔,清除蝶窦病变并充分引流。在接近蝶窦自然口附近取带蒂鼻中隔黏骨膜瓣,将其覆盖在蝶窦裸露的骨质处。结果术后蝶窦黏膜水肿及结痂明显减轻,术腔上皮化时间缩短。1年内21例患者均无复发,蝶窦口无闭锁。结论鼻内镜下经鼻中隔后端入路的蝶窦开放术及局部带蒂鼻中隔黏骨膜瓣覆盖裸露骨质可以减少术腔结痂并加速愈合,扩大的蝶窦术腔便于术后清理,且避免再次闭锁,但应严格控制手术适应证。

OBJECTIVE To investigate the safety,feasibility and efficacy of the modified endoscopic sinus surgery on sphenoidal diseases via nasal septum approach.METHODS Twenty-one patients with isolated sphenoidal lesions were enrolled and underwent the modified endoscopic sinus surgery via nasal septum approach.If necessary,removed sphenoidal rostrum and septum of sphenoid sinus to enlarge the sphenoid sinus cavity,cleared the lesion of the sphenoid sinus and fully drained.The mucoperiosteal flap of nasal septum was taken near the natural outlet of sphenoid sinus and covered on the exposed bone of sphenoid sinus.RESULTSPostoperative mucosa edema and crusting were relieved,the re-epithelializing time was shortened and smooth sphenoidal drainage was observed.No serious complications were observed in all patients during one-year follow up.CONCLUSION The modified endoscopic sinus surgery on sphenoidal diseases and the application of the pedicled nasal septum flap can help reduce the postoperative crusting,and ensured a good clinical outcome.The enlarged opening of sphenoid sinus facilitated nasal management after operation and enabled sphenoidal drainage.Consider surgery with strictly controlling of the surgery indication.