鼻窦骨化纤维瘤手术探讨

Surgery of ossifying fibroma of the sinuses

目的 探讨鼻窦骨化纤维瘤的手术进路 ,分析各种手术的方法和特点。方法 回顾性分析我院 1994年 8月～ 2 0 0 1年 7月治疗的鼻窦骨化纤维瘤 35例的临床资料。结果 35例中男 2 3例 ,女 12例 ,年龄 2～ 4 5岁 ,平均 17 1岁。手术方式包括鼻侧切开手术、鼻内镜下手术、冠状切口颅骨切开手术 (包括冠状切口颅骨切开联合鼻内镜下手术及冠状切口颅骨切开联合鼻侧切开手术 )、Caldwell Luc进路手术。鼻内镜下手术 2 2例 ,彻底切除 8例 ,部分切除 14例。 2例在影像导航辅助下手术。鼻侧切开手术 6例 ,彻底切除 4例 ,部分切除 2例。冠状切口颅骨切开手术 5例 ,彻底切除 2例 ,部分切除 3例 ,有 2例联合鼻内镜下手术 ,1例联合鼻侧切开手术。Caldwell Luc进路手术 2例 ,均为部分切除。 35例患者随访 33例 ,失访 2例 ,平均随访时间 3 5年。结果 14例无复发 ,14例带瘤生存 ,5例复发后再次手术。结论 鼻窦骨化纤维瘤手术进路的选择主要依据病变范围 ,同时要考虑器官结构的功能、美容、手术的难易程度以及术者的经验和习惯等。

Objective To explore the different surgical choices for treating the ossifying fibroma of the sinuses. To summarize the management and characteristics of each surgical operation. Methods A retrospective evaluation of thirty-five patients with ossifying fibroma of the sinuses from August 1994 to July 2001 was presented. Results Among 22 patients operated by nasal endoscopic management, complete ossifying fibroma removed was achieved in 8 cases, and the majority part of tumor removed in 14 cases. Six patients were operated through a lateral rhinotomy with radical operation in 4 cases. Five ossifying fibromas were removed with a coronal incision. Two cases underwent Caldwell-Luc’ surgery. The clinical symptoms, location of ossifying fibroma, and surgical procedures were analyzed. All patients outcomes were successful, no serious complication from the surgical technique occurred. Thirty-three cases were followed-up for 1 to 8 years with an average of three and half years. Fourteen patients had no recurrence, fourteen cases lived with the remains of ossifying fibroma, and five cases recurred. Conclusions The choice of surgical operations on ossifying fibroma of the sinuses was mainly decided by the location of ossifying fibroma, in the meanwhile, the organ function, the cosmetology, the surgical degree of difficulty, and the doctor′s experience were taken into account.