鼻窦黏液囊肿病因分析及手术进路探讨  

Clinical Investigation of Etiological and Surgical Approaches of Nasal Sinus Mucoceles

作　　者：游学俊[1] 刘争[1] 徐凯[1] 高起学[1] 崔永华[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院耳鼻咽喉-头颈外科,武汉430030

出　　处：《华中科技大学学报（医学版）》2007年第4期539-541,共3页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：教育部留学回国人员科研启动基金资助项目(No.[2004]176号);湖北省人事厅留学回国人员科技活动择优资助项目(No.[2003]136号)

摘　　要：目的分析鼻窦黏液囊肿的成因并探讨其手术进路。方法回顾性分析152例鼻窦黏液囊肿的好发部位、病因学、手术治疗方法,总结其手术治疗的进路选择原则。结果囊肿位于额窦72例,上颌窦38例,筛窦15例,蝶窦9例,囊肿累及多个窦腔18例。位于不同鼻窦的152例囊肿中,97例(63.8%)经鼻内进路予以切除。72例额窦黏液囊肿患者中,有23例(31.9%)需采用额部冠状切口骨成形进路予以切除,13例(18.1%)采用鼻内、鼻外联合进路得以切除,较早期的7例采用Jansen-Ritter术式予以切除。术后经过平均60个月的随访,治愈率95.4%,复发率4.6%。结论传统的鼻外进路鼻窦手术是导致额窦、上颌窦黏液囊肿发生的常见原因。鼻内进路手术能有效避免鼻窦黏液囊肿的发生。位于上颌窦内侧、筛窦、蝶窦、眶纸板内侧的额窦黏液囊肿应采取鼻内进路进行手术;位于眶纸板外侧的额窦黏液囊肿应采取冠状切口骨成形手术的方法予以切除;位于上颌窦前和(或)外侧的囊肿则需采取Caldwell-Luc进路进行手术。Objective To investigate the etiology of nasal sinus mucoceles and the surgical approaches. Methods Predilection sites, etiology and surgical operations of nasal sinus mucoceles were retrospectively analyzed in 152 patients suffering from nasal sinus mucoceles and summarize the surgical approaches. Results In 152 patients with nasal sinus mucoceles, mucoceles were located in frontal sinus in 72 cases, in maxillary sinus in 38 cases, in ethmoidal sinus in 15 cases, in sphenoidal sinus in 19 cases, and mucoceles involved in more than one nasal sinus in 18 cases. In all 152 patients, the mucoceles were resected via the intra-nasal approach in 97 cases （63.8 %）. Among 72 patients with frontal sinus mucoceles, the lesions were resected via frontal region coronal incision osteoplastic approach in 23 cases （31.9 % ）, via combined intra-extra approach in 13 cases （18.1 %）, and mucoceles in earlier stage in 7 cases were resected by Jansen-Ritter＇s operation. After a follow-up period of 60 months, the healing rate was 95.4% and recurrent rate was 4.6 %. Conclusion Traditional extra-nasal approach operations are the common causes of frontal sinus mucoceles or ethmoidal sinus mucoceles. Intra-nasal approach operation can effectively avoid the occurrence of nasal sinus mucoceles. Mucoceles located in ethmoidal sinus, sphenoidal sinus, interior part of maxillary sinus and frontal sinus mucoceles located in internal part of the orbital wall are resected via the intra nasal approach. Frontal sinus mucoceles located in the exterior part of the orbital wall are resected via the frontal region coronal incision osteoplastic approach. The cysts located in the anterior and/or exterior part of maxillary sinus are resected by Caldwell-Luc procedure.

关 键 词：鼻窦 黏液囊肿 手术进路 

分 类 号：R730.269[医药卫生—肿瘤]