双鼻腔窥器在内镜经鼻鞍区手术中的应用

Application of double nasal blade in endoscopic transnasal surgery

目的 评估利用双鼻腔窥器进行经鼻内镜鞍区病变手术的术后效果,探讨该鼻腔窥器的有效性。方法 哈尔滨医科大学附属第一医院神经外科2020年9月—2021年9月利用双鼻腔窥器对34例鞍区病变患者进行手术,随访患者的切除程度,术后鼻腔并发症。结果 根治性切除患者91.2%(31/34),次全切8.8%(3/34)。85%的患者在术后1周视力有改善。术后患者无严重并发症。术中脑脊液漏14.7%(5/34),应用鼻中隔黏膜瓣修补,术后无脑脊液漏。有两例患者术中未发现脑脊液漏,术后出现脑脊液鼻漏,在术后第7天行鼻中隔黏膜瓣修补脑脊液漏。患者术后两周内通气比例是88.2%(30/34),术后两周有嗅觉的比例是17.6%(6/34)。术后3个月有嗅觉比例是91.2%。结论 双鼻腔窥器能够有效地保护鼻腔黏膜,减少鼻腔黏膜对镜头的污染,同时对于内镜和手术器械进出鼻腔具有非常重要的引导作用,特别适用于初学的内镜外科医生,鼻腔窥器能够引导内镜和手术器械准确无误地快速到达手术区域,尤其是没有内镜引导下的左侧鼻腔。这样就可以缩短内镜手术医生的学习曲线,方便术者和助手共同完成手术。

Objective To evaluate the postoperative effect of transnasal endoscopic surgery for sellar lesions with double nasal speculum, and to explore the effectiveness of this nasal speculum. Methods 34 patients with lesions in the sellar region underwent operation using double nasal speculum in Department of Neurosurgery, the First Affiliated Hospital of Harbin Medical University from September 2020 to September 2021. The extent of resection and postoperative nasal complications were followed up. Results 91.2%(31/34) of the patients underwent radical resection and 8.8%(3/34) subtotal resection. Visual acuity improved in 85% of patients at 1 week postoperatively. The patients had no serious postoperative complications. Intraoperative cerebrospinal fluid leakage was 14.7%(5/34), which was repaired with nasal septum mucosal flap, and there was no postoperative cerebrospinal fluid leakage. In two patients, no cerebrospinal fluid leakage was found during surgery, and cerebrospinal fluid rhinorrhea occurred after surgery, and nasal septal mucosal flap repair was performed on the 7th day after 1st surgery. The proportion with patients ventilated within two weeks after surgery was 88.2%(30/34), and the proportion of patients with olfaction 2 weeks after surgery was 17.6%(6/34). The proportion of olfaction 3 months after surgery was 91.2%. Conclusions The dual-nasal speculum can effectively protect the nasal mucosa, reduce the pollution of the nasal mucosa to the lens, and play a very important role in guiding the endoscope and surgical instruments into and out of the nasal cavity, especially for novice endoscopic surgeons. The nasal speculum can guide the endoscope and surgical instruments to reach the operating area accurately and quickly,especially the left nasal cavity without the guidance of the endoscope. In this way,the learning curve of endoscopic surgeons can be shortened,and it is convenient for the surgeon and assistant to complete the operation together.