鼻内镜下泪前隐窝入路上颌窦良性病变切除临床分析

发布时间：2018-01-30 22:43

本文关键词： 鼻内镜泪前隐窝入路上颌窦良性病变　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：1研究背景在鼻窦疾病中以上颌窦病变多见。其中内翻性乳头状瘤、上颌窦息肉、上颌骨囊肿、出血坏死性鼻息肉、上颌窦囊肿、上颌窦后鼻孔息肉等属于良性病变;鳞状细胞癌、腺癌、腺样囊性癌、恶性黑色素瘤等属于恶性病变。由于这些病变的复发性以及难治性,怎样彻底清除病变,提高预后成为越来越多耳鼻喉科大夫研究的方面。2007年周兵等提出的鼻腔外侧壁切开(现称为泪前隐窝入路PLRA)为清除复杂上颌窦病变提供可靠而又简便的手术方法,值得我们学习研究。2目的通过研究分析经鼻内镜下泪前隐窝入路(PLRA)切除上颌窦良性疾病的案例,探讨其应用及注意事项,为以后的临床工作提供更好的指导作用。3方法采用回顾性分析法进行研究,收集84例行鼻内镜下泪前隐窝入路(PLRA)进行手术治疗的患者,病变性质为良性。其中包括内翻性乳头状瘤(Inverted papilloma,IP)患者 44 例,上颌窦息肉(Maxillary polyps)11 例,上颌窦囊肿6例,上颌骨囊肿6例,含牙囊肿2例,出血坏死性鼻息肉4例,上颌窦后鼻孔息肉3例,翼腭窝神经鞘瘤2例,上窦壁及眶底骨折2例,牙源性角化囊肿1例,胆脂瘤1例,脑脊液鼻漏1例,口腔上颌窦瘘1例。病例来自于2010年8月-2016年12月期间就诊我院并行该术式人群。采用静吸复合麻醉的方法下行本研究术式,评估手术时间以及住院时间长短、术中情况及术后规律行鼻内镜检查观察恢复情况,总结手术经验及疗效。4结果该样本各患者手术时间从50分钟至225分钟不等,住院时间从3天至28天不等,平均手术、住院时间分别为90分钟、7.6天。其中有4例IP患者复发,经再次手术后,随访时间段内无复发。术后观察未见明显并发症。5结论对于上颌窦复杂病变,采取PLRA能够将上颌窦自然入口及经下鼻道开窗无法清除的病变彻底清除,通过适当扩大PLR入路开窗能够充分暴露病变,彻底清除病变黏膜及下方一定范围的骨质是手术成功的关键。手术时间以及住院时间较合理,无明显并发症发生。
[Abstract]:Background: maxillary sinus lesions are common in sinus diseases, including inverted papilloma, maxillary sinus polyp, maxillary cyst, hemorrhagic necrotic nasal polyp, maxillary sinus cyst. The posterior nostril polyp of maxillary sinus is a benign lesion. Squamous cell carcinoma, adenocarcinoma, adenoid cystic carcinoma and malignant melanoma are malignant lesions. In 2007 Zhou Bing et al proposed the lateral wall incision of the nasal cavity (now called the anterior lacrimal recess approach PLRAA). To provide a reliable and simple surgical method for the removal of complex maxillary sinus lesions. Objective to analyze the cases of benign maxillary sinus diseases by transnasal endoscopic approach of anterior lacrimal recess (PLRAA) and discuss its application and attention. Methods A retrospective analysis was used to study 84 cases of patients undergoing surgery by endoscopic approach of anterior lacrimal recess (PLRAA). The lesions were benign in nature, including 44 patients with inverted papilloma papillomafida (IPP). Maxillary polyps)11 was found in maxillary sinus polyp, maxillary sinus cyst in 6 cases, maxillary cyst in 6 cases, dental cyst in 2 cases and hemorrhagic necrotic nasal polyp in 4 cases. There were 3 cases of posterior maxillary sinus polyp, 2 cases of pterygopalatine fossa neurilemmoma, 2 cases of upper sinus wall and orbital floor fractures, 1 case of odontogenic keratocyst, 1 case of cholesteatoma and 1 case of cerebrospinal fluid rhinorrhea. One case of oral maxillary sinus fistula was treated with this method from August 2010 to December 2016 in our hospital. The duration of operation, length of stay in hospital, intraoperative and postoperative regular endoscopic examination were evaluated to observe the recovery. Results the operation time ranged from 50 minutes to 225 minutes, and the hospitalization time ranged from 3 days to 28 days. The average operation time was 90 minutes. 7. 6 days. Among them, 4 patients with IP recurred, and no recurrence occurred during the follow-up period after reoperation. Conclusion there is no obvious complication of 5. 5 in the maxillary sinus. PLRA can completely remove the lesions which can not be cleared by opening the natural entrance of maxillary sinus and through the inferior nasal canal. The lesions can be fully exposed by properly expanding the PLR approach. The key to the success of the operation is to thoroughly clear the diseased mucous membrane and a certain range of bone below. The operation time and the hospital stay are reasonable and there are no obvious complications.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R765.9

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