鼻内镜下泪前隐窝入路治疗上颌窦复杂病变的疗效分析

Effect analysis of prelacrimal recess approach in the treatment of complex maxillary sinus lesions under nasal endoscope

目的探讨分析鼻内镜下泪前隐窝入路治疗复杂上颌窦病变的手术疗效。方法回顾性分析2018年5月~2020年5月我科收治的18例复杂上颌窦病变患者的手术方式及疗效,其中男性11例,女性7例,年龄25~75岁。术前均行鼻内镜、鼻窦CT检查及MRI检查。术后组织病理学报告内翻性乳头状瘤11例,出血坏死性息肉2例,复发性上颌窦霉菌2例,复发性上颌窦后鼻孔息肉2例,上颌窦含牙囊肿1例,所有手术均采用全身麻醉下进行,手术先鼻内镜下常规开放扩大上颌窦口,切除鼻腔及其他鼻窦病变,再经泪前隐窝入路进入上颌窦,彻底切除病变。术后定期随访6到24个月。结果术后1例患者出现面部麻木感,1个月后逐渐消失,余患者无溢泪,无鼻甲萎缩、坏死及面部麻木等并发症,1例患者内翻性乳头状瘤复发。结论泪前隐窝入路手术创伤小,能充分显露上颌窦,无手术操作死角,彻底切除病变,极大程度避免复发再次手术,无并发症,对于复杂的上颌窦病变,是值得选择的术式。

Objective To investigate the effect of prelacrimal recess approach under nasal endoscope in the treatment of complex maxillary sinus lesions and infratemporal fossa benign tumors.Methods Retrospective analysis was performed on 18 patients aged from 25 to 75 years old with complex maxillary sinus lesions and infratemporal fossa benign tumors admitted to our department from May 2018 to May 2020,including 11 males and 7 females.Preoperative nasal endoscopy,sinus CT examination and MRI examination were performed.Postoperative histopathological reports included 11 cases of inverted papilloma,2 cases of bleeding and necrotic polyp,2 cases of recurrent mold in maxillary sinus,2 cases of recurrent posterior nostril polyp of maxillary sinus,1 case of dental cyst in maxillary sinus.After successful general anesthesia,the maxillary sinus was opened and enlarged under nasal endoscope,the nasal cavity and other sinus lesions were removed,then the lesions of maxillary sinus were completely removed via prelacrimal recess approach.Results Postoperative facial numbness appeared in 1 patient,which gradually disappeared after 1 month.The remaining patients had no dacryorrhea,turbinate atrophy,necrosis,facial numbness and other complications,1 patient had a recurrence of inverted papilloma.Conclusions The prelacrimal recess approach under nasal endoscope is less invasive,can fully expose maxillary sinus,and has fewer complications.It is a worthy choice for complex maxillary sinus lesions.