泪前隐窝入路内镜下切除上颌窦黏液囊肿的可行性与安全性分析

Feasibility and safety of endoscopic resection of maxillary sinus mucoceles through the prelacrimal recess approach

目的探讨与分析泪前隐窝入路内镜下切除上颌窦黏液囊肿的可行性与安全性。方法选取2017年8月至2020年1月间选择河南省尉氏县人民医院收治的86例上颌窦黏液囊肿患者作为研究对象,根据随机信封抽签原则分为观察组与对照组,每组43例。观察组给予泪前隐窝入路内镜下切除治疗,对照组给予上颌窦根治手术治疗。结果所有患者均顺利完成手术,两组术后1d与术后14d的血清皮质醇含量高于术前1d,观察组低于对照组,差异均有统计学意义(均P <0.05)。观察组术后3个月的总有效率为97.7%,高于对照组的86.0%,差异有统计学意义(P <0.05)。观察组术后3个月的麻木、肿胀、感染等并发症发生率为4.7%,低于对照组的25.6%,差异有统计学意义(P <0.05)。术后随访12个月,观察组的复发率为2.3%,低于对照组的16.3%,差异有统计学意义(P <0.05)。结论泪前隐窝入路内镜下切除上颌窦黏液囊肿能最大限度地保留鼻腔鼻窦的正常解剖结构和功能,从而减低患者的应激反应,减少术后并发症的发生,提高总体治疗效果,降低复发率。

Objective To explore and analyze the feasibility and safety of endoscopic resection of maxillary sinus mucoceles through the prelacrimal recess approach. Methods From August 2017 to January 2020,86 patients with maxillary sinus mucoceles diagnosed and treated in Weishi County People’s Hospital were selected. The patients were randomly divided into an observation group and a control group with 43 patients in each group. The observation group underwent endoscopic resection through prelacrimal recess approach,and the control group underwent radical surgery. Results The operation was completed successfully in all patients. The serum cortisol levels were high in the two groups at 1 d and 14 d after the operation compared with those at 1 d before the operation and the levels were lower in the observation group than in the control group(all P < 0. 05). The overall efficacy rate was 97. 7% in the observation group which was higher than 86. 0% of the control group at 3 months after the operation(P < 0. 05). The incidence of complications including numbness,swelling and infection was 4. 7% in the observation group which was lower than 25. 6% of the control group at 3 months after the operation(P < 0. 05). After 12 months of followedup,the recurrence was was 2. 3% in the observation group,which was lower than 16. 3% of the control group(P < 0. 05). Conclusion Endoscopic resection of maxillary sinus mucoceles through the prelacrimal recess approach can preserve the normal anatomical structure and function of the nasal cavity and paranasal sinuses to the greatest extent,and thereby it reduces patient’s stress response and improve overall treatment efficacy and reduce the recurrence rate.