内镜经翼突入路处理蝶窦外侧隐窝病变4例(附文献复习)

Endoscopic transpterygoid intervention for lesions of lateral recess of sphenoid sinus in 4cases(with literature review)

目的:探讨内镜经翼突入路处理蝶窦外侧隐窝病变的相关解剖及手术方式。方法:回顾性分析内镜经鼻经翼突入路治疗的4例蝶窦外侧隐窝病变患者的临床资料,其中脑膜脑膨出并脑脊液鼻漏1例,自发性脑脊液漏2例,慢性侵袭性真菌性蝶窦炎伴颅底破坏1例,均接受了全身麻醉下内镜经鼻经翼突入路蝶窦外侧隐窝病变的清理并修补手术。结果:1例慢性侵袭性真菌性蝶窦炎伴颅底破坏和1例脑膜脑膨出患者术区病灶完全清除并一次性修补成功,2例自发性脑脊液鼻漏患者一次性修补成功。慢性侵袭性真菌性蝶窦炎伴颅底破坏患者于术后出现患侧硬腭麻木,术后6个月症状逐渐缓解。4例患者随访6～45个月,平均22.75个月,无复发。结论:内镜经鼻经翼突入路处理蝶窦外侧隐窝病变,是一种微创、安全且有效的手术方式。

Objective:To investigate the anatomy and application of endoscopic transpterygoid intervention in lesions of lateral recess of sphenoid sinus(LRSS).Method:Four hospitalized patients with lesions of LRSS were studied.The clinical presentations included spontaneous cerebrospinal fuild(CSF)leakage in 2 cases,meningoencephaolece complicated CSF leakage in 1 case and chronic invasive fungal sphenoid sinusitis invading the base of the middle fossa in1 case.Endoscopic transpterygoid intervention and repairment of skull base defects were performed under general anesthesia.Result:The operations were successfu1 in all patients.One patient suffered from postoperative palatal hypesthesia and all the symptoms mentioned above relieved gradually 6 months after operation.No recurrence was found during the follow-up ranging from 6 to 45 months(mean follow-up period,22.75 months).Conclusion:Endoscopic transpterygoid intervention in lesions of LRSS is a minimally invasive and safe surgical approach.