鼻内镜下泪前隐窝入路微创治疗累及上颌窦的复杂内翻性乳头状瘤

发布时间：2018-04-13 05:49

本文选题：乳头状瘤 + 内翻　；参考：《中国微创外科杂志》2017年06期

【摘要】：目的探讨经鼻内镜泪前隐窝入路微创治疗累及上颌窦的复杂内翻性乳头状瘤的可行性及疗效。方法回顾性分析2013年1月~2015年10月18例经鼻内镜泪前隐窝入路手术治疗累及上颌窦的复杂内翻性乳头状瘤的临床资料,男14例,女4例,年龄17~73岁,平均49.3岁。术前行CT、MRI检查,明确病变累及泪前隐窝、齿槽隐窝并伴有上颌窦各壁多发骨质破坏。经鼻内镜泪前隐窝入路清除上颌窦内病变,处理肿瘤根蒂处黏膜并清除受累骨质,视病变范围处理筛窦、蝶窦、额窦。术后定期鼻内镜检查随访,观察症状改善、并发症及肿瘤原位复发、远处转移情况。结果 18例均顺利完成手术,术后经鼻内镜检查、换药,随访6~40个月,平均24个月。9例术后患侧鼻腔通气改善,头痛等临床症状消失,鼻内镜检查窦腔上皮化,无视力下降、复视、溢泪等并发症发生;5例术后囊泡或肉芽增生,经鼻内镜换药2~4周消失;2例病理提示伴癌变,术后放射治疗,随访9、13个月未见复发及远处转移;2例术后复发,经再次鼻内镜手术,扩大切除病变,分别继续随访12、15个月未见复发。结论泪前隐窝入路治疗复杂上颌窦内翻性乳头状瘤,可彻底清除上颌窦病灶,手术损伤小,术后并发症少,是可行的手术方式。
[Abstract]:Objective to evaluate the feasibility and efficacy of transnasal endoscopic approach for minimally invasive treatment of complex varus papilloma involving maxillary sinus.Methods from January 2013 to October 2015, 18 cases of complex varus papilloma involving maxillary sinus were treated by transnasal endoscopic anterior lacrimal recess approach. The clinical data were analyzed retrospectively. There were 14 males and 4 females, aged 1773 years with an average of 49.3 years.Ct MRI was performed before operation to identify the lesions involving anterior lacrimal recess, alveolar recess and multiple bone destruction in the walls of maxillary sinus.The lesions of maxillary sinus were cleared by the approach of anterior lacrimal recess under nasal endoscope, the mucous membrane at the root of the tumor was treated and the involved bone was cleared. The ethmoid sinus, sphenoid sinus and frontal sinus were treated according to the scope of the lesion.The symptoms, complications, tumor recurrence and distant metastasis were observed.Results all the 18 cases were successfully operated. The patients were followed up for 6 ~ 40 months. The mean 24 months were 9 cases with improved nasal ventilation, headache and other clinical symptoms disappeared, nasal endoscope examination sinus cavity epithelization, no loss of vision.Complications such as diplopia, lacrimal discharge and other complications occurred in 5 cases of postoperative vesicle or granulation hyperplasia, and 2 cases with malignant change were revealed by nasal endoscope change of medicine for 24 weeks. Postoperative radiotherapy was followed up for 9 months, no recurrence was found in 13 months, and 2 cases with distant metastasis were recurred after operation.After the second endoscopic surgery, the lesion was resected and followed up for 12 months. No recurrence was found in 15 months.Conclusion the anterior lacrimal recess approach for the treatment of complex maxillary sinus inverted papilloma can completely remove the lesions of maxillary sinus with less surgical injury and less postoperative complications.
【作者单位】：首都医科大学附属北京安贞医院耳鼻咽喉头颈外科;
【基金】：北京市卫生系统高层次卫生技术人才培养计划资助(2014-2-011)
【分类号】：R739.6

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