小儿先天性鼻腔鼻窦肿物的临床诊疗观察

Clinical diagnosis and treatment of congenital nasal sinus mass in children

目的 探讨小儿先天性鼻腔鼻窦肿物的诊断及鼻内镜手术治疗的安全性和有效性。方法 回顾性分析上海交通大学医学院附属新华医院收治的24例先天性鼻腔鼻窦肿物患儿的临床资料。术前进行鼻内镜、鼻窦CT和MRI检查,全部病例经鼻内镜下鼻腔鼻窦肿物切除术,术后随访手术疗效。结果 24例中良性占位17例,其中脑膜脑膨出8例、骨化纤维瘤3例、软骨间叶性错构瘤2例、骨纤维结构不良1例、肌纤维瘤1例、畸胎瘤1例、毛细血管瘤1例;恶性占位7例中B细胞淋巴瘤2例、胚胎性横纹肌肉瘤2例、间叶性软骨肉瘤1例、嗅神经母细胞瘤1例、黏液表皮样癌1例。除2例胚胎性横纹肌肉瘤,1例间叶性软骨肉瘤和1例嗅神经母细胞瘤病损范围较广未能切除已经死亡外,其余20例均完全切除病变,随访1.5~7.5年未见明显复发。结论 小儿鼻腔鼻窦肿物良性较多见,通常以手术完全切除为主,术前鼻内镜检查、鼻窦增强薄层CT及MRI检查对诊断、手术方式制定和风险评估十分必要。鼻内镜手术可以完全切除大多数病变,具有创伤小、视野清晰和临床效果好等优点。

Objective To explore the safety and effectiveness of diagnosis and endoscopic surgical treatment of congenital nasal sinus masses in children. Methods A retrospective analysis of the clinical data of 24 congenital nasal sinus mass cases in children admitted to the Xinhua Hospital, which is affiliated with the Shanghai Jiao Tong University School of Medicine. Preoperative nasal endoscopy, sinus CT, and MRI examination were performed, and all patients underwent endoscopic mass resection, with follow-up of surgical outcomes. Results Of the 24 cases, 17 were benign, consisting of 8 meningocele cases, 3 ossifying fibroma cases, 2 nasal chondromesenchymal hamartoma cases, 1 case of poor bone fiber structure, 1 myofibroma case, 1 teratoma case, and 1 capillary hemangioma case. Meanwhile, the remaining 7 cases were malignant, consisting of 2 B-cell lymphoma cases, 2 embryonal rhabdomyosarcoma cases, 1 mesenchymal chondrosarcoma case, 1 olfactory neuroblastoma case, and 1 mucoepidermoid carcinoma case. Aside from the two embryonal rhabdomyosarcoma cases, the one mesenchymal chondrosarcoma case and the one olfactory neuroblastoma case had passed away;thus, only the remaining 20 of the 24 cases were completely resected. No recurrence was observed in 1.5-7.5 years in the remaining cases. Conclusion There were more benign nasal sinus mass cases in children, which were usually resolved with complete surgical resection. Preoperative endoscopic examination, thin-layer CT, and MRI examination were found to be necessary for diagnosis, surgical procedure formulation, and risk assessment. Moreover, nasal endoscopic surgery can completely remove most of these lesions, with the advantages of small trauma, clear vision, and good clinical results.