蝶窦外侧隐窝病变的诊断与鼻内镜治疗

发布时间：2018-06-09 11:17

本文选题：蝶窦 + 诊断　；参考：《临床耳鼻咽喉头颈外科杂志》2014年11期

【摘要】：目的:探讨如何正确诊断蝶窦外侧隐窝病变及经鼻内镜下翼突径路处理该区域病变的相关问题。方法:26例蝶窦外侧隐窝病变患者,术前均经高分辨率CT扫描和增强磁共振检查,在全身麻醉下行经鼻内镜下翼突径路清除蝶窦外侧隐窝病变,诊断为脑脊液鼻漏伴脑膜脑膨出者同时行颅底修补手术。结果:术后病理确诊,4例为脑脊液鼻漏伴脑膜脑膨出,均一次手术修补成功;10例为蝶窦囊肿;5例为非侵袭性真菌性鼻窦炎;7例为慢性蝶窦炎。其中9例术后合并患侧颜面部上颌神经支配区域麻木感,但未给予特殊处理,约6个月后症状逐渐缓解。术后全部患者给予定期鼻内镜复查、糖皮质激素喷鼻剂、口服标准桃金娘油等治疗。随访6~53个月,病变无复发。结论:高分辨率CT扫描同时结合增强磁共振检查对于诊断蝶窦外侧隐窝病变具有重要意义;采用鼻内镜下经翼突入路处理蝶窦外侧隐窝病变,是一种微创、简捷、安全的手术入路。
[Abstract]:Objective: to investigate how to correctly diagnose the lesions of the lateral recess of sphenoid sinus and how to deal with the lesions of the region by endoscopic approach of pterygoid process. Methods Twenty six patients with diseases of lateral recess of sphenoid sinus were examined by high-resolution CT and enhanced magnetic resonance imaging before operation. The lesions of lateral recess of sphenoid sinus were cleared by nasal endoscopic pterygoid pathway under general anesthesia. Patients with cerebrospinal fluid rhinorrhea and meningocele were treated with skull base repair at the same time. Results: four cases of cerebrospinal fluid rhinorrhea with meningeal encephalocele were confirmed by pathology after operation. 10 cases of sphenoid sinus cyst 5 cases of noninvasive fungal sinusitis 7 cases of chronic sphenoid sinusitis were successfully repaired in one operation. Among them, 9 cases were complicated with anaesthesia of maxillary innervation area in facial region of the affected side, but no special treatment was given, and the symptoms gradually relieved after 6 months. All patients were treated with regular endoscopic examination, glucocorticoid nasal spray, oral standard myrtle oil and so on. Follow-up for 6 ~ 53 months showed no recurrence. Conclusion: high resolution CT scan combined with enhanced magnetic resonance imaging is of great significance in the diagnosis of the lesions of the lateral recess of the sphenoid sinus, and it is a minimally invasive and simple way to treat the lesions of the lateral recess of the sphenoid sinus by transpterional approach under nasal endoscope. A safe surgical approach.
【作者单位】：首都医科大学宣武医院耳鼻咽喉头颈外科;
【分类号】：R765.9

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