鼻腔外侧壁切开入路处理上颌窦病变的临床分析

Clinical analysis of maxillary sinus lesions treated by lateral wall incision of nasal cavity

目的分析鼻腔外侧壁切开入路处理上颌窦病变的临床疗效。方法对19例病变部位位于上颌窦前下壁的患者采取外侧壁切开入路手术。结果 7例上颌窦囊肿,9例上颌窦后鼻孔息肉,2例内翻性乳头状瘤,1例鼻窦异物。术中发现病变部位主要位于上颌窦,病变范围较广,根蒂部位于前、内下壁,常规中鼻道入路处理比较困难。采用外侧壁切开后,能将病变彻底清除,降低复发机率。随访6~10个月,术腔恢复良好,均已上皮化,鼻腔通畅,下鼻道无粘连,无溢泪相关症状。结论鼻腔外侧壁切开入路处理上颌窦病变,能彻底清除病变,同时保留了下鼻道黏膜的完整性,避免泪道损伤。是处理上颌窦前下壁病变微创的非常好的手术入路。

Objective To analyze the clinical effect of lateral incision of the nasal cavity in the treatment of maxillary sinus lesions.Methods 19 patients with the lesion located in the anterior inferior wall of maxillary sinus were treated with lateral wall incision.Results There were 7 cases of maxillary sinus cysts,9 cases of postmaxillary nostril polyps,2 cases of inverted papilloma,and 1 case of foreign body in nasal sinus.During the operation,the lesions were mainly located in the maxillary sinus,with a wide range of lesions,and the root pedicle was located in the anterior and medial inferior walls.It was difficult to deal with the conventional middle nasal approach.After the lateral wall incision,the lesion can be completely removed and the recurrence rate can be reduced.Follow-up for 6 to 10 months showed that the operative lumen recovered well,with epithelialization,unobobstructed nasal cavity,no adhesions in inferior nasal passage,and no symptoms related to lacrimatorrhea.Conclusion Maxillary sinus lesions can be completely removed by lateral incision of the nasal cavity,and the integrity of the mucosa of the inferior nasal passage can be preserved to avoid lacrimal passage injury.It is a very good minimally invasive surgical approach for the treatment of lesions on the anterior inferior wall of maxillary sinus.