经额开颅术后继发性额窦炎的治疗体会

The treatment of frontal sinusitis after transfrontal craniotomy

目的 探讨前额径路继发性额窦炎手术方式选择。方法 回顾性分析我科自2010年1月~2017年12月间21例因前额径路继发性额窦炎患者病历资料,单侧17例,双侧4例,一例合并额叶硬膜外脓肿,一例出现额部皮肤瘘管。所有患者均在全麻下行鼻内镜手术,彻底清除额窦内骨腊及生物胶等异物,根据额窦口骨质增生情况选择术式,术后所有患者均未放置鼻额管。结果 17例行Draf IIA或Draf IIB术式,4例行Draf III术式,鼻外辅助切口4例。术后所有患者均未出现脑脊液鼻漏,且对患者随访3年未见额窦炎复发。结论 前额径路继发性额窦炎首先彻底清除额窦内骨腊或生物胶等异物,并充分扩大额窦口,保证额窦的通畅引流至关重要。对于双侧额窦病变可选择Draf III术式,而单侧病变则可以根据窦口周围骨质增生情况酌情选择Draf IIA或者Draf IIB术式。

Objective To explore the surgical methods of frontal sinusitis after transfrontal craniotomy. Methods The clinical data of 21 patients with frontal sinusitis after transfrontal craniotomy January 2010 to December 2017 were retrospectively analyzed.There were 17 unilateral cases, 4 bilateral cases, 1 case with frontal epidural abscess and 1 case with frontal skin fistula. All patients underwent endoscopic sinus surgery under general anesthesia, and the foreign bodies such as bone wax or bio glue in frontal sinus were completely removed. The operation mode was selected according to the bone hyperplasia of frontal sinus ostium. No nasofrontal canal was placed in all patients after operation. Results 17 cases were treated with draft IIA or draft IIB, 4 cases with draft III operation and4 cases with external nasal incision. No cerebrospinal fluid rhinorrhea was found in all patients after operation, and no recurrence occurred in 3 years of follow-up. Conclusion for the secondary frontal sinusitis through the frontal approach, the foreign bodies such as bone wax or bio glue in the frontal sinus should be thoroughly removed, and the ostium of frontal sinus should be fully enlarged.It is vital to ensure unobstructed drainage of the frontal sinuses.For bilateral lesions, the Draf III operation should be performed, and the unilateral lesions should be treated with Draf IIA or Draf IIB according to the hyperosteogeny around the frontal ostium.